Provider Demographics
NPI:1972855575
Name:SPECTRUM HEALTH CARE, INC.
Entity Type:Organization
Organization Name:SPECTRUM HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-860-6100
Mailing Address - Street 1:74 PACIFIC AVE
Mailing Address - Street 2:80
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-3216
Mailing Address - Country:US
Mailing Address - Phone:201-860-6100
Mailing Address - Fax:
Practice Address - Street 1:74 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-3216
Practice Address - Country:US
Practice Address - Phone:201-860-6100
Practice Address - Fax:201-860-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10CC00058200261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7605706OtherWFNJ