Organization
SPECIAL NEEDS SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JAMES O'BRIEN (PRESIDENT)
(602) 295-8987
Entity
Organization
Contact information
Practice address
6954 E TETON CIR, MESA, AZ 85207-0939
(602) 295-8987
(480) 659-3763
Mailing address
6954 E TETON CIR, MESA, AZ 85207-0939
(602) 295-8987
(480) 659-3763
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
271653
AZ
252Y00000X
Early Intervention Provider Agency
271653
AZ
253Z00000X
In Home Supportive Care Agency
271653
AZ
305R00000X
Preferred Provider Organization
271653
AZ
385H00000X
Respite Care
271653
AZ
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
271653
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02315
ARIZONA QUALIFIED VENDOR AGREEMENT NUMBER
AZ
01
—
271653
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
02/23/2010
Last updated
02/23/2010
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