MEDICARE: SPECTRUM HUMAN SERVICES,INC

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	251S00000X	Community/Behavioral Health Agency	821956	MI

General Provider Information

NPI Number	:	1578687612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HUMAN SERVICES,INC

Provider Business Mailing Address
First Line	:	28303 JOY RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-5524
Country	:	US
Telephone Number	:	734-458-8736
Fax Number	:	734-458-8836

Provider Business Practice Location Address
First Line	:	7430 2ND AVE
Second Line	:	SUITE 900
City	:	DETROIT
State	:	MI
Zip	:	48202-2739
Country	:	US
Telephone Number	:	313-456-6000
Fax Number	:	313-935-9911

Authorized Official
Title or Position	:	PRESIDENT,CEOT
Name	:	MR. ROGER I SWANINGER
Credential	:	ACSW,MSW
Telephone Number	:	734-458-8736

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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