Provider Demographics
NPI:1922472406
Name:FULL SPECTRUM HOME CARE SERVICES
Entity Type:Organization
Organization Name:FULL SPECTRUM HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-291-8241
Mailing Address - Street 1:3116 VAIL PASS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3116 VAIL PASS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4301
Practice Address - Country:US
Practice Address - Phone:719-291-8241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA1OtherKAISER-PERMANENTE
A1OtherAFLAC
COA4OtherTRICARE
A4OtherHUMANA
COA1OtherHUMANA
COA1OtherUNITED HEALTH CARE INSURANCE
COA4OtherAETNA
COA1OtherTRICARE
COA4OtherUNITED HEALTH CARE INSURANCE
COA4OtherMETLIFE
COA1OtherMETLIFE
COA1OtherAFLAC
COA4OtherBLUE CROSS BLUE SHIELD INSURANCE
COA4OtherKAISER-PERMANENTE
COA4Medicaid
COA1Medicaid