Provider Demographics
NPI:1205832987
Name:SPECTRUM PRIVATE CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SPECTRUM PRIVATE CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROWBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-299-7100
Mailing Address - Street 1:155 S 18TH ST
Mailing Address - Street 2:STE 260
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5654
Mailing Address - Country:US
Mailing Address - Phone:913-299-7100
Mailing Address - Fax:913-299-7102
Practice Address - Street 1:155 S 18TH ST
Practice Address - Street 2:STE 260
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5654
Practice Address - Country:US
Practice Address - Phone:913-299-7100
Practice Address - Fax:913-299-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA105020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-8008Medicare ID - Type UnspecifiedHOME HEALTH