Provider Demographics
NPI:1336493550
Name:SPECTRUM FAMILY CARE LLC
Entity Type:Organization
Organization Name:SPECTRUM FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-412-8866
Mailing Address - Street 1:61 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:GA
Mailing Address - Zip Code:31635-5318
Mailing Address - Country:US
Mailing Address - Phone:229-232-7093
Mailing Address - Fax:229-253-0054
Practice Address - Street 1:3403 BEMISS RD
Practice Address - Street 2:SUITE C
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7062
Practice Address - Country:US
Practice Address - Phone:229-412-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherEIN