Provider Demographics
NPI:1679236293
Name:SPECTRUM OF LIGHT INC
Entity Type:Organization
Organization Name:SPECTRUM OF LIGHT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OSOB
Authorized Official - Middle Name:I
Authorized Official - Last Name:ADEN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW, MSW
Authorized Official - Phone:612-323-0157
Mailing Address - Street 1:1325 AMERICAN BLVD E STE 5A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1152
Mailing Address - Country:US
Mailing Address - Phone:612-323-0157
Mailing Address - Fax:
Practice Address - Street 1:8051 33RD AVE S UNIT 274
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-5001
Practice Address - Country:US
Practice Address - Phone:763-732-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health