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General NPI Number Information
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NPI Number | 1407998842
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Entity Type | Organization
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Legal Business Name | SPECTRUM FOR LIVING DEVELOPMENT, INC.
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 210 RIVERVALE ROAD, SUITE 3
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City | RIVER VALE
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-358-8000
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Fax | 201-358-8089
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Provider Business Mailing Address
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Address Line | 210 RIVERVALE ROAD, SUITE 3
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City | RIVER VALE
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State | NJ
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Zip | 07675
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Country | US
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Telephone | 201-358-8000
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Fax | 201-358-8089
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Authorized Official
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Title or Position | CFO
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Name | WILLIAM G. MUILENBURG
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Credential |
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Telephone | 201-358-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 83011
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License Number State | NJ
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