Provider Demographics
NPI:1922642529
Name:SPECTRUM LIFE SOLUTIONS
Entity Type:Organization
Organization Name:SPECTRUM LIFE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MARTINEZ LOMBARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:540-661-2906
Mailing Address - Street 1:PO BOX 8154
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22404-8154
Mailing Address - Country:US
Mailing Address - Phone:540-324-4555
Mailing Address - Fax:
Practice Address - Street 1:611 MAPLE GROVE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6824
Practice Address - Country:US
Practice Address - Phone:540-324-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities