Provider Demographics
NPI:1437661006
Name:SPERO FAMILY SERVICES
Entity Type:Organization
Organization Name:SPERO FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY & IT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:618-242-1070
Mailing Address - Street 1:2023 RICHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2884
Mailing Address - Country:US
Mailing Address - Phone:618-242-1070
Mailing Address - Fax:
Practice Address - Street 1:403 N 42ND ST STE C
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2297
Practice Address - Country:US
Practice Address - Phone:618-242-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPERO FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021068-11251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5000-IPI-029Medicaid