Provider Demographics
NPI:1962452383
Name:SPECTRUM CHARTER SCHOOL
Entity type:Organization
Organization Name:SPECTRUM CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-374-8130
Mailing Address - Street 1:4369 NORTHERN PIKE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2807
Mailing Address - Country:US
Mailing Address - Phone:412-374-8130
Mailing Address - Fax:412-374-9629
Practice Address - Street 1:4369 NORTHERN PIKE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2807
Practice Address - Country:US
Practice Address - Phone:412-374-8130
Practice Address - Fax:412-374-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018219490001Medicaid