Provider Demographics
NPI:1528724051
Name:SPERO FAMILY SERVICES
Entity type:Organization
Organization Name:SPERO FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-242-1070
Mailing Address - Street 1:2023 RICHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9835 OLD BAINBRIDGE TRL
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5831
Practice Address - Country:US
Practice Address - Phone:618-242-6944
Practice Address - Fax:618-242-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPERO FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-09
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5000-IPI-029Medicaid