Provider Demographics
NPI:1558845271
Name:SPECIAL LIVES, INC.
Entity Type:Organization
Organization Name:SPECIAL LIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PLANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:631-820-1984
Mailing Address - Street 1:15 SHEARWATER WAY
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4313
Mailing Address - Country:US
Mailing Address - Phone:631-820-1984
Mailing Address - Fax:
Practice Address - Street 1:15 SHEARWATER WAY
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4313
Practice Address - Country:US
Practice Address - Phone:631-820-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1952664765OtherSPECIAL EDUCATOR