Provider Demographics
NPI:1508239450
Name:SPECTRA HUMAN SERVICES, INC.
Entity Type:Organization
Organization Name:SPECTRA HUMAN SERVICES, INC.
Other - Org Name:SPECTRUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:303-986-1001
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:D231
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-462-4358
Mailing Address - Fax:303-232-4601
Practice Address - Street 1:3333 S WADSWORTH BLVD
Practice Address - Street 2:D231
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5122
Practice Address - Country:US
Practice Address - Phone:303-462-4358
Practice Address - Fax:303-232-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-01
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25776061Medicaid