Provider Demographics
NPI:1376395632
Name:SPECTRUM SUCCESS LLC
Entity Type:Organization
Organization Name:SPECTRUM SUCCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:YAJURVANTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-790-7413
Mailing Address - Street 1:3940 ESTATES PATH
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1030
Mailing Address - Country:US
Mailing Address - Phone:201-496-0525
Mailing Address - Fax:
Practice Address - Street 1:4300 WESTBROOK RD UNIT E
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4987
Practice Address - Country:US
Practice Address - Phone:770-790-7413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty