Provider Demographics
NPI:1518142785
Name:SPECTRUM THERAPEUTIC SERVICES INC
Entity Type:Organization
Organization Name:SPECTRUM THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:FERRULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC SLP
Authorized Official - Phone:570-265-3993
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-0366
Mailing Address - Country:US
Mailing Address - Phone:570-265-3993
Mailing Address - Fax:
Practice Address - Street 1:101 YORK AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-1923
Practice Address - Country:US
Practice Address - Phone:570-265-3993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005963L261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019297730003Medicaid