Provider Demographics
NPI:1841414604
Name:PANHANDLE SPECIAL NEEDS, INC.
Entity Type:Organization
Organization Name:PANHANDLE SPECIAL NEEDS, INC.
Other - Org Name:PSNI
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRINITY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:208-263-7022
Mailing Address - Street 1:1424 N BOYER AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2218
Mailing Address - Country:US
Mailing Address - Phone:208-263-7022
Mailing Address - Fax:208-265-0176
Practice Address - Street 1:1424 N BOYER AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2218
Practice Address - Country:US
Practice Address - Phone:208-263-7022
Practice Address - Fax:208-265-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1PSNI065251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0024651Medicaid