Provider Demographics
NPI:1780095588
Name:SPECTRUM CONSULTING SERVICES
Entity type:Organization
Organization Name:SPECTRUM CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-654-4714
Mailing Address - Street 1:129 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-1601
Mailing Address - Country:US
Mailing Address - Phone:440-654-4714
Mailing Address - Fax:
Practice Address - Street 1:129 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-1601
Practice Address - Country:US
Practice Address - Phone:440-654-4714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1093982251B00000X, 252Y00000X
OHRS052920343900000X, 347C00000X
OHS-0016958251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No347C00000XTransportation ServicesPrivate Vehicle