Organization
SPECTRUM FOR LIVING GROUP HOMES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK MICHELSON (PRESIDENT/CEO)
(201) 358-5063
Entity
Organization
Contact information
Practice address
81 RIVERVALE RD, RIVERVALE, NJ 07675-6214
(201) 722-0904
Mailing address
210 RIVERVALE RD, SUITE 3, RIVERVALE, NJ 07675-6281
(201) 358-8000
(201) 358-8089
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
SA555
NJ
Other
Enumeration date
06/22/2015
Last updated
06/22/2015
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