Organization Active NPI

Spectrum Heights LLC.

  • Community/Behavioral Health Agency
  • Atlanta, GA
National Provider Identifier
1265963003
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
16097319 Issued in GA
Legal business name
SPECTRUM HEIGHTS LLC.
Practice address
436 Collier Rd NW
Atlanta, GA 30309-1202
Phone
(646) 251-0799
NPI assigned
Mar 23, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Olumide Edemodu, M.S. BCBA
Title
Owner/Behavior Analyst
Phone
(646) 251-0799

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 16097319 GA
Community/Behavioral Health Agency 251S00000X 16097319 GA Primary

Addresses

Primary practice location

436 Collier Rd NW
Atlanta, GA 30309-1202

Mailing address

436 Collier Rd NW
Atlanta, GA 30309-1202
Phone (646) 251-0799

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1265963003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "436 COLLIER RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091202",
            "telephone_number": "646-251-0799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 COLLIER RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091202",
            "telephone_number": "646-251-0799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEIGHTS LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "EDEMODU",
        "authorized_official_first_name": "OLUMIDE",
        "authorized_official_title_or_position": "OWNER/BEHAVIOR ANALYST",
        "authorized_official_telephone_number": "646-251-0799",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S. BCBA"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "GA",
            "license": "16097319",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "16097319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.