| Spectrum Recovery Inc | |
|
111 Dennis Dr Ste 115 Sanford NC 27330-6461 | |
| (919) 708-5063 | |
| (919) 774-3155 |
| Full Name | Spectrum Recovery Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 111 Dennis Dr Ste 115, Sanford, North Carolina |
| Authorized Official Name and Position | Aja Williams (COO) |
| Authorized Official Contact | 9197085063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Recovery Inc Po Box 2926 Sanford NC 27331-2926 Ph: (919) 708-5063 | Spectrum Recovery Inc 111 Dennis Dr Ste 115 Sanford NC 27330-6461 Ph: (919) 708-5063 |
| NPI Number | 1396288072 |
|---|---|
| Provider Enumeration Date | 11/29/2016 |
| Last Update Date | 11/08/2024 |
| Certification Date | 11/08/2024 |
| Medicare PECOS PAC ID | 7315207933 |
|---|---|
| Medicare Enrollment ID | O20180130002224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396288072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | James Youngchull Kim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1386684330 PECOS PAC ID: 8123019320 Enrollment ID: I20080422000176 |
| Provider Name | Lisa A Antonick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043229016 PECOS PAC ID: 1850381674 Enrollment ID: I20091006000157 |
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