Provider Demographics
NPI:1609337773
Name:SPECIAL OUTINGS, ACTIVITIES, AND RECREATIONS LLC
Entity Type:Organization
Organization Name:SPECIAL OUTINGS, ACTIVITIES, AND RECREATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/ ACTIVITIES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:JACKSON-CLOCKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-329-2796
Mailing Address - Street 1:9465 W HINSDALE PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-4168
Mailing Address - Country:US
Mailing Address - Phone:720-329-2796
Mailing Address - Fax:
Practice Address - Street 1:9465 W HINSDALE PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-4168
Practice Address - Country:US
Practice Address - Phone:720-329-2796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care