Healthcare Provider Details

I. General information

NPI: 1093912685
Provider Name (Legal Business Name): SPECIAL NEEDS PROGRAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 ROUTE 66
GHENT NY
12075
US

IV. Provider business mailing address

1351 ROUTE 66 P.O. BOX 349
GHENT NY
12075
US

V. Phone/Fax

Practice location:
  • Phone: 518-822-1054
  • Fax: 518-822-0739
Mailing address:
  • Phone: 518-822-1054
  • Fax: 518-822-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY MEROL HIME
Title or Position: CEO
Credential:
Phone: 518-822-1054