1578687612 NPI number — SPECTRUM HUMAN SERVICES,INC

Table of content: (NPI 1578687612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578687612 NPI number — SPECTRUM HUMAN SERVICES,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM HUMAN SERVICES,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578687612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28303 JOY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48185-5524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-458-8736
Provider Business Mailing Address Fax Number:
734-458-8836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7430 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48202-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-456-6000
Provider Business Practice Location Address Fax Number:
313-935-9911
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWANINGER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT,CEOT
Authorized Official Telephone Number:
734-458-8736

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  821956 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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