Provider Demographics
NPI:1417441791
Name:SPECTRUM SENIORS LLC
Entity Type:Organization
Organization Name:SPECTRUM SENIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:HAN LIU
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-885-9600
Mailing Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1560
Mailing Address - Country:US
Mailing Address - Phone:650-885-9600
Mailing Address - Fax:
Practice Address - Street 1:725 PATRICIA AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3146
Practice Address - Country:US
Practice Address - Phone:508-859-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA414700066253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care