Provider Demographics
NPI:1700251923
Name:SPECTRUM HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SPECTRUM HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENTURIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-813-2905
Mailing Address - Street 1:22165 DEBRA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2330
Mailing Address - Country:US
Mailing Address - Phone:949-813-2905
Mailing Address - Fax:
Practice Address - Street 1:22165 DEBRA ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2330
Practice Address - Country:US
Practice Address - Phone:949-813-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health