Provider Demographics
NPI:1407928237
Name:SPECTRUM OF SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:SPECTRUM OF SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:216-939-2065
Mailing Address - Street 1:2900 DETROIT AVENUE
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2710
Mailing Address - Country:US
Mailing Address - Phone:216-939-2065
Mailing Address - Fax:216-939-2077
Practice Address - Street 1:2900 DETROIT AVENUE
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-2710
Practice Address - Country:US
Practice Address - Phone:216-939-2065
Practice Address - Fax:216-939-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0339261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10232OtherDEPT OF MENTAL HEALTH