Provider Demographics
NPI:1295854776
Name:ST. VINCENT'S SPECIAL NEEDS CENTER, INC.
Entity Type:Organization
Organization Name:ST. VINCENT'S SPECIAL NEEDS CENTER, INC.
Other - Org Name:ST. VINCENT'S SPECIAL NEEDS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:203-375-6400
Mailing Address - Street 1:95 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5435
Mailing Address - Country:US
Mailing Address - Phone:203-375-6400
Mailing Address - Fax:203-380-1190
Practice Address - Street 1:95 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5435
Practice Address - Country:US
Practice Address - Phone:203-375-6400
Practice Address - Fax:203-380-1190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT'S MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-28
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative Communication
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040028Medicaid