Provider Demographics
NPI:1578885166
Name:SPECIAL NEEDS SERVICES, LLC
Entity Type:Organization
Organization Name:SPECIAL NEEDS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-295-8987
Mailing Address - Street 1:6954 E TETON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-0939
Mailing Address - Country:US
Mailing Address - Phone:602-295-8987
Mailing Address - Fax:480-659-3763
Practice Address - Street 1:6954 E TETON CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-0939
Practice Address - Country:US
Practice Address - Phone:602-295-8987
Practice Address - Fax:480-659-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ271653251C00000X, 252Y00000X, 253Z00000X, 305R00000X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ271653OtherAHCCCS PROVIDER NUMBER
AZ02315OtherARIZONA QUALIFIED VENDOR AGREEMENT NUMBER