=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801420641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIAL NEEDS HOMES LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2020
-----------------------------------------------------
Last Update Date | 03/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 803 11TH CT SW
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32962-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-584-5522
-----------------------------------------------------
Fax | 772-778-0279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 11TH CT SW
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32962-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-584-5522
-----------------------------------------------------
Fax | 772-778-0279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHARLES STADELMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-584-5522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------