Provider Demographics
NPI:1508989666
Name:SPECTRUM LIFE CARE SERVICES INC
Entity Type:Organization
Organization Name:SPECTRUM LIFE CARE SERVICES INC
Other - Org Name:SPECTRUM LIFE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CIAVARELLA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:954-499-5794
Mailing Address - Street 1:12260 SW 53RD ST STE 611
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-3320
Mailing Address - Country:US
Mailing Address - Phone:954-499-5794
Mailing Address - Fax:954-252-4844
Practice Address - Street 1:12260 SW 53RD ST STE 611
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-3320
Practice Address - Country:US
Practice Address - Phone:954-499-5794
Practice Address - Fax:954-309-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL228629251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL681078196Medicaid
FL681078198Medicaid