Provider Demographics
NPI:1366007445
Name:SPECIAL INSTRUCTION SERVICES LLC
Entity Type:Organization
Organization Name:SPECIAL INSTRUCTION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-277-4944
Mailing Address - Street 1:322 MIDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5412
Mailing Address - Country:US
Mailing Address - Phone:347-277-4944
Mailing Address - Fax:
Practice Address - Street 1:322 MIDWOOD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5412
Practice Address - Country:US
Practice Address - Phone:347-277-4944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency