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General NPI Number Information
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NPI Number | 1093912685
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Entity Type | Organization
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Legal Business Name | SPECIAL NEEDS PROGRAM, INC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 1351 ROUTE 66
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City | GHENT
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State | NY
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Zip | 12075
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Country | US
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Telephone | 518-822-1054
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Fax | 518-822-0739
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Provider Business Mailing Address
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Address Line | 1351 ROUTE 66 P.O. BOX 349
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City | GHENT
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State | NY
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Zip | 12075
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Country | US
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Telephone | 518-822-1054
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Fax | 518-822-0739
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY MEROL HIME
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Credential |
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Telephone | 518-822-1054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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