Provider Demographics
NPI:1992242812
Name:SPECIALNEEDS4SPECIAL PPL
Entity type:Organization
Organization Name:SPECIALNEEDS4SPECIAL PPL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-442-4149
Mailing Address - Street 1:12040 PITCAIRN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4724
Mailing Address - Country:US
Mailing Address - Phone:352-442-4149
Mailing Address - Fax:352-556-2350
Practice Address - Street 1:12040 PITCAIRN ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4724
Practice Address - Country:US
Practice Address - Phone:352-442-4149
Practice Address - Fax:352-556-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL691661996253Z00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No253Z00000XAgenciesIn Home Supportive Care