Provider Demographics
NPI:1003448309
Name:SPECTRUM LIVING SOLUTIONS
Entity Type:Organization
Organization Name:SPECTRUM LIVING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:630-248-8892
Mailing Address - Street 1:4375 N VANTAGE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4986
Mailing Address - Country:US
Mailing Address - Phone:630-717-7546
Mailing Address - Fax:
Practice Address - Street 1:3677 W WEIR RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5906
Practice Address - Country:US
Practice Address - Phone:479-871-2481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health