Provider Demographics
NPI:1174861280
Name:SPECTRA AUTISM CENTER
Entity Type:Organization
Organization Name:SPECTRA AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEARHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-935-5200
Mailing Address - Street 1:2424 9TH AVE
Mailing Address - Street 2:APARTMENT 3108
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4043
Mailing Address - Country:US
Mailing Address - Phone:610-751-2911
Mailing Address - Fax:
Practice Address - Street 1:2424 9TH AVE
Practice Address - Street 2:APARTMENT 3108
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-4043
Practice Address - Country:US
Practice Address - Phone:610-751-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57189251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)