Spectrum Habilitation Service Inc.

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

SPECTRUM HABILITATION SERVICE INC.

Practice address

310 Magnolia Walk Lane
College Park, GA 30349

Phone

(404) 276-2222

Fax

(404) 691-4354

NPI assigned

Feb 9, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Lydia Jackson-Smith

Title

Director

Phone

(404) 276-2222

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Spectrum Habilitation Services #A, #B, #C, #D, #E Doing business as

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

{
    "created_epoch": "1265673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1760714299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 MAGNOLIA WALK LN",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "303494072",
            "fax_number": "404-691-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 MAGNOLIA WALK LANE",
            "city": "COLLEGE PARK",
            "state": "GA",
            "postal_code": "30349",
            "telephone_number": "404-276-2222",
            "fax_number": "404-691-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HABILITATION SERVICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-09",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "JACKSON-SMITH",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-276-2222",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252549320B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Habilitation Services #A, #B, #C, #D, #E",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Rehabilitation Clinic/Center in College Park, GA
• Providers in College Park, GA by specialty
• Rehabilitation Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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.