=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487892345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL NEEDS SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2009
-----------------------------------------------------
Last Update Date | 01/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12012 COUNTY ROAD 283 E
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75791-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-330-0821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12012 COUNTY ROAD 283 E
-----------------------------------------------------
City | WHITEHOUSE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75791-6010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-330-0821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RAY BOCKOVER
-----------------------------------------------------
Credential | ATP,CRTS
-----------------------------------------------------
Telephone | 903-330-0821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------