MEDICARE: SPECTRUM DEVELOPMENTAL SERVICES, INCORPORATED

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780271437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM DEVELOPMENTAL SERVICES, INCORPORATED

Provider Business Mailing Address
First Line	:	355 KENT DR
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-1453
Country	:	US
Telephone Number	:	330-957-9713
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 PORTAGE TRL STE A
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1741
Country	:	US
Telephone Number	:	330-957-9713
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. TODD WETZEL
Credential	:
Telephone Number	:	330-957-9713

Provider Enumeration Date	:	12/29/2020
Last Update Date	:	12/29/2020

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