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General NPI Number Information
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NPI Number | 1992242812
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Entity Type | Organization
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Legal Business Name | SPECIALNEEDS4SPECIAL PPL
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 12040 PITCAIRN ST
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City | BROOKSVILLE
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State | FL
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Zip | 34613-4724
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Country | US
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Telephone | 352-442-4149
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Fax | 352-556-2350
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Provider Business Mailing Address
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Address Line | 12040 PITCAIRN ST
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City | BROOKSVILLE
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State | FL
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Zip | 34613-4724
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Country | US
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Telephone | 352-442-4149
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Fax | 352-556-2350
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH JUNE DUNCAN
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Credential |
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Telephone | 352-442-4149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 691661996
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 691661996
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License Number State | FL
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