Provider Demographics
NPI:1730858853
Name:SPECTRA HOMECARE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SPECTRA HOMECARE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKITA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-424-7146
Mailing Address - Street 1:14424 SOUTHFIELD FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-3587
Mailing Address - Country:US
Mailing Address - Phone:313-424-7146
Mailing Address - Fax:
Practice Address - Street 1:14424 SOUTHFIELD FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-3587
Practice Address - Country:US
Practice Address - Phone:313-424-7146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty