Provider Demographics
NPI:1720298342
Name:SPECTRUM CARE ACADEMY OF E-TOWN
Entity type:Organization
Organization Name:SPECTRUM CARE ACADEMY OF E-TOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-673-5035
Mailing Address - Street 1:309 EVERGREEN RD.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243
Mailing Address - Country:US
Mailing Address - Phone:714-673-5035
Mailing Address - Fax:270-384-9126
Practice Address - Street 1:461 FOWLER LANE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8546
Practice Address - Country:US
Practice Address - Phone:714-673-5035
Practice Address - Fax:270-234-0781
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM CARE ACADEMY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY950019323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7101079920Medicaid
KY04000030Medicaid