Basic Information
| Provider Information | |||||||||
| NPI: | 1487608485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECTRUM HEALTH SYSTEMS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MECHANIC ST. | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087925400 | ||||||||
| FaxNumber: | 5088310074 | ||||||||
| Practice Location | |||||||||
| Address1: | 585 LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016051906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088543320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| AuthorizedOfficialLastName: | ELLIS | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5087925400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 988189 | 01 | MA | NETWORK HEALTH | OTHER | 2220002001 | 01 | MA | BCBS OF MA SUBSTANCE ABUS | OTHER | 690527 | 01 | MA | TUFTS | OTHER | M18684 | 01 | MA | BCBS OF MA MENTAL HEALTH | OTHER | 1002900 | 01 | MA | BEACON | OTHER | 1306421 | 05 | MA | MEDICAID | 1308785 | 05 | MA | MEDICAID | 903163 | 01 | MA | HPHC | OTHER |