Provider Demographics
NPI:1265582324
Name:SPECTRUM DEVELOPMENTAL SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM DEVELOPMENTAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:704-969-2575
Mailing Address - Street 1:11816 CHURCHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-7000
Mailing Address - Country:US
Mailing Address - Phone:704-969-2575
Mailing Address - Fax:704-943-3778
Practice Address - Street 1:11816 CHURCHFIELD LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-7000
Practice Address - Country:US
Practice Address - Phone:704-969-2575
Practice Address - Fax:704-943-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services