Provider Demographics
NPI:1538198361
Name:SPECIALIZED VOCATIONAL SERVICES, INC
Entity type:Organization
Organization Name:SPECIALIZED VOCATIONAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-376-3550
Mailing Address - Street 1:320 10TH ST
Mailing Address - Street 2:P.O. BOX 451
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2316
Mailing Address - Country:US
Mailing Address - Phone:507-376-3550
Mailing Address - Fax:507-376-6412
Practice Address - Street 1:320 10TH ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2316
Practice Address - Country:US
Practice Address - Phone:507-376-3550
Practice Address - Fax:507-376-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1021018-1-WS320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities