Provider Demographics
NPI:1073816856
Name:SPECIAL KIDS INTERVENTION PROGRAM, INC
Entity Type:Organization
Organization Name:SPECIAL KIDS INTERVENTION PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-605-2800
Mailing Address - Street 1:401 BLOOMINGDALE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2070
Mailing Address - Country:US
Mailing Address - Phone:718-605-2800
Mailing Address - Fax:718-605-2848
Practice Address - Street 1:15645 84TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2617
Practice Address - Country:US
Practice Address - Phone:718-738-1800
Practice Address - Fax:718-848-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)