Provider Demographics
NPI:1558853077
Name:SPECTRUM COMMUNITIES OF MISSISSIPPI LLC
Entity Type:Organization
Organization Name:SPECTRUM COMMUNITIES OF MISSISSIPPI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-600-8675
Mailing Address - Street 1:4525 FLAT SHOALS PKWY STE 401
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:270 TRACE COLONY PARK DR STE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8810
Practice Address - Country:US
Practice Address - Phone:404-600-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home