Provider Demographics
NPI:1073244174
Name:SPECTRUM POWERED, LLC
Entity Type:Organization
Organization Name:SPECTRUM POWERED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WIEMHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:BOBA
Authorized Official - Phone:805-874-2142
Mailing Address - Street 1:1135 HYDE PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:EURGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:805-874-2142
Mailing Address - Fax:
Practice Address - Street 1:1135 HYDE PARK PLACE
Practice Address - Street 2:
Practice Address - City:EURGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:805-874-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency