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General NPI Number Information
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NPI Number | 1891663340
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Entity Type | Organization
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Legal Business Name | SPECTRUM CARE ACADEMY BLUEGRASS I
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1175 CANE VALLEY RD
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City | COLUMBIA
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State | KY
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Zip | 42728
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Country | US
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Telephone | 714-673-5035
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Fax |
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Provider Business Mailing Address
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Address Line | 309 EVERGREEN RD.
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City | LOUISVILLE
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State | KY
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Zip | 40243
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Country | US
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Telephone | 714-673-5035
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Fax |
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | REBECCA PERALTA
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Credential | M.A.
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Telephone | 714-673-5035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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