Provider Demographics
NPI:1750604963
Name:SPERO FAMILY SERVICES
Entity type:Organization
Organization Name:SPERO FAMILY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-242-1070
Mailing Address - Street 1:2023 RICHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2884
Mailing Address - Country:US
Mailing Address - Phone:618-242-1070
Mailing Address - Fax:618-242-9381
Practice Address - Street 1:107 SHILOH DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-7301
Practice Address - Country:US
Practice Address - Phone:618-242-6944
Practice Address - Fax:618-242-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPERO FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-03
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
IL021068-11251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5000-IPI-029Medicaid