Provider Demographics
NPI:1205832987
Name:SPECTRUM PRIVATE CARE SERVICES, LLC
Entity type:Organization
Organization Name:SPECTRUM PRIVATE CARE SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OREL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:913-299-7100
Mailing Address - Street 1:7734 HEDGE LANE TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66227-3017
Mailing Address - Country:US
Mailing Address - Phone:913-299-7100
Mailing Address - Fax:913-299-7102
Practice Address - Street 1:7734 HEDGE LANE TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66227-3017
Practice Address - Country:US
Practice Address - Phone:913-299-7100
Practice Address - Fax:913-299-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA105020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100242600AMedicaid