Provider Demographics
NPI:1184836470
Name:SPECIAL NEEDS SPECIALISTS INC.
Entity type:Organization
Organization Name:SPECIAL NEEDS SPECIALISTS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-935-4663
Mailing Address - Street 1:1250 N. CONVENT STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1006
Mailing Address - Country:US
Mailing Address - Phone:815-935-4663
Mailing Address - Fax:815-935-4660
Practice Address - Street 1:1250 N CONVENT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1085
Practice Address - Country:US
Practice Address - Phone:815-935-4663
Practice Address - Fax:815-935-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
IL1010830251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
14-8186Medicare PIN