Provider Demographics
NPI:1487863098
Name:SPECTRUM CARE ACADEMY, INC.
Entity Type:Organization
Organization Name:SPECTRUM CARE ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-384-6402
Mailing Address - Street 1:PO BOX 911
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-0911
Mailing Address - Country:US
Mailing Address - Phone:270-384-6444
Mailing Address - Fax:270-384-9126
Practice Address - Street 1:6100 JACKSON HWY
Practice Address - Street 2:
Practice Address - City:CAVE CITY
Practice Address - State:KY
Practice Address - Zip Code:42127-9312
Practice Address - Country:US
Practice Address - Phone:270-678-4706
Practice Address - Fax:270-678-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY950008323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY04005013Medicaid