Spectrum Heights LLC.

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

Last updated

Mar 23, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Olumide Edemodu, M.S. BCBANPI 1689083867

Title

Owner/Behavior Analyst

Phone

(646) 251-0799

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Olumide Edemodu, BCBA

  • Behavior Analyst
  • Atlanta, GA
  • NPI 1689083867
  Authorized official Same address or phone

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": []
}

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• 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.