Provider Demographics
NPI:1114375987
Name:SPECTRUM HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:SPECTRUM HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AYANLE
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-423-5419
Mailing Address - Street 1:110 2ND ST S
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1662
Mailing Address - Country:US
Mailing Address - Phone:612-423-5419
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:SUITE # 204
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:612-423-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health