1114294923 NPI number — SPECIAL NEEDS, INC.

Table of content: (NPI 1114294923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114294923 NPI number — SPECIAL NEEDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECIAL NEEDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114294923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5331 MOUNT VIEW RD
Provider Second Line Business Mailing Address:
172
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37013-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-941-3039
Provider Business Mailing Address Fax Number:
615-941-3039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353 BATTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANE RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37013-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-941-3039
Provider Business Practice Location Address Fax Number:
615-941-3039
Provider Enumeration Date:
11/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SANGUINETTI
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE SECRETARY
Authorized Official Telephone Number:
615-941-3039

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  PSS0000000127 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSS0000000127 . This is a "DEPARTMENT OF HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: PT00000059963 . This is a "PT OT BOARD OF EXAMINERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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