Provider Demographics
NPI:1003374364
Name:A SPECIAL NEEDS CONNECTION AND MEDICAID WAIVERS LLC
Entity Type:Organization
Organization Name:A SPECIAL NEEDS CONNECTION AND MEDICAID WAIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-453-5249
Mailing Address - Street 1:5684 PREMINGER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-3856
Mailing Address - Country:US
Mailing Address - Phone:719-453-5249
Mailing Address - Fax:719-348-8777
Practice Address - Street 1:5684 PREMINGER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-3856
Practice Address - Country:US
Practice Address - Phone:719-453-5249
Practice Address - Fax:719-348-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management