Provider Demographics
NPI:1235509530
Name:SPECTRUM SUPPORTS COORDINATION
Entity Type:Organization
Organization Name:SPECTRUM SUPPORTS COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-571-1481
Mailing Address - Street 1:470 CARNEGIE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-2042
Mailing Address - Country:US
Mailing Address - Phone:412-571-1481
Mailing Address - Fax:
Practice Address - Street 1:470 CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-2042
Practice Address - Country:US
Practice Address - Phone:412-571-1481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1030220130001251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management