Provider Demographics
NPI:1548833130
Name:SPECTRUM OF LIGHT FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM OF LIGHT FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-246-9880
Mailing Address - Street 1:3181 E SPAULDING AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3181 E SPAULDING AVE APT 103
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2251
Practice Address - Country:US
Practice Address - Phone:719-246-9880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health