MEDICARE: SPECTRUM SUPPORTS COORDINATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	1030220130001	PA

General Provider Information

NPI Number	:	1235509530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM SUPPORTS COORDINATION

Provider Business Mailing Address
First Line	:	470 CARNEGIE DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-2042
Country	:	US
Telephone Number	:	412-571-1481
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 CARNEGIE DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-2042
Country	:	US
Telephone Number	:	412-571-1481
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOAH HACKETT
Credential	:
Telephone Number	:	412-571-1481

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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