Provider Demographics
NPI:1770877342
Name:SPECTRUM SOCIAL AND RECREATION SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM SOCIAL AND RECREATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER / BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:512-524-5482
Mailing Address - Street 1:1509 W NORTH LOOP BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2004
Mailing Address - Country:US
Mailing Address - Phone:512-524-5482
Mailing Address - Fax:512-524-1177
Practice Address - Street 1:1509 W NORTH LOOP BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2004
Practice Address - Country:US
Practice Address - Phone:512-524-5482
Practice Address - Fax:512-524-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency