Provider Demographics
NPI:1710192364
Name:SPECTRUM FOR LIVING
Entity Type:Organization
Organization Name:SPECTRUM FOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOMEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-358-8083
Mailing Address - Street 1:210 RIVERVALE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6281
Mailing Address - Country:US
Mailing Address - Phone:201-358-8083
Mailing Address - Fax:201-358-1823
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:201-784-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4465601Medicare ID - Type Unspecified