Provider Demographics
NPI:1639318306
Name:SPECTRUM FOR LIVING DEVELOPMENT, INC.
Entity Type:Organization
Organization Name:SPECTRUM FOR LIVING DEVELOPMENT, INC.
Other - Org Name:SPECTRUM FOR LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARCHIONDA
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, MBA, MPHA
Authorized Official - Phone:201-358-8086
Mailing Address - Street 1:210 RIVERVALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6281
Mailing Address - Country:US
Mailing Address - Phone:201-358-8000
Mailing Address - Fax:201-358-8089
Practice Address - Street 1:50 BLANCH AVE
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1228
Practice Address - Country:US
Practice Address - Phone:201-784-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ83011261QA0600X
NJ31G012315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities