Provider Demographics
NPI:1497918023
Name:SPECIALIZED SERVICES & PERSONNEL INC
Entity Type:Organization
Organization Name:SPECIALIZED SERVICES & PERSONNEL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-944-8125
Mailing Address - Street 1:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-1356
Mailing Address - Country:US
Mailing Address - Phone:910-944-8125
Mailing Address - Fax:910-944-7705
Practice Address - Street 1:301 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2823
Practice Address - Country:US
Practice Address - Phone:910-944-8125
Practice Address - Fax:910-944-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC15453747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601762Medicaid