Provider Demographics
NPI:1992569404
Name:SPECTRUM OF LOVE
Entity type:Organization
Organization Name:SPECTRUM OF LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-339-8737
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:972-339-8737
Mailing Address - Fax:
Practice Address - Street 1:840 GREENVIEW DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2438
Practice Address - Country:US
Practice Address - Phone:972-339-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty