Healthcare Provider Details

I. General information

NPI: 1578885166
Provider Name (Legal Business Name): SPECIAL NEEDS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6954 E TETON CIR
MESA AZ
85207-0939
US

IV. Provider business mailing address

6954 E TETON CIR
MESA AZ
85207-0939
US

V. Phone/Fax

Practice location:
  • Phone: 602-295-8987
  • Fax: 480-659-3763
Mailing address:
  • Phone: 602-295-8987
  • Fax: 480-659-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number271653
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number271653
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number271653
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number271653
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number271653
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number271653
License Number StateAZ

VIII. Authorized Official

Name: MR. DANIEL JAMES O'BRIEN
Title or Position: PRESIDENT
Credential:
Phone: 602-295-8987