Provider Demographics
NPI:1336795731
Name:UNITED SPECTRUM CENTER
Entity Type:Organization
Organization Name:UNITED SPECTRUM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZINET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-400-1127
Mailing Address - Street 1:22065 PALMS WAY APT 205
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8014
Mailing Address - Country:US
Mailing Address - Phone:561-400-1127
Mailing Address - Fax:
Practice Address - Street 1:3845 WEST HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEEFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-400-1127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services