Provider Demographics
NPI:1437751997
Name:SPECTRUM HOME CARE
Entity Type:Organization
Organization Name:SPECTRUM HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-355-0603
Mailing Address - Street 1:1006 E CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1936
Mailing Address - Country:US
Mailing Address - Phone:701-355-0603
Mailing Address - Fax:701-355-0609
Practice Address - Street 1:1006 E CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1936
Practice Address - Country:US
Practice Address - Phone:701-355-0603
Practice Address - Fax:701-355-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456517Medicaid