Provider Demographics
NPI:1710378518
Name:SPECTRUM COLLEGE TRANSITION PROGRAM
Entity Type:Organization
Organization Name:SPECTRUM COLLEGE TRANSITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-443-7331
Mailing Address - Street 1:9659 N. HAYDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-443-7331
Mailing Address - Fax:480-998-1046
Practice Address - Street 1:10931 E LAUREL LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3095
Practice Address - Country:US
Practice Address - Phone:480-443-7331
Practice Address - Fax:480-998-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility