Provider Demographics
NPI:1447318258
Name:EARLY INTERVENTIONS, LLC
Entity type:Organization
Organization Name:EARLY INTERVENTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-597-9378
Mailing Address - Street 1:1401 GOLD COAST RD.
Mailing Address - Street 2:STE. 600
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 GOLD COAST RD.
Practice Address - Street 2:STE. 600
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5811
Practice Address - Country:US
Practice Address - Phone:402-597-9378
Practice Address - Fax:402-597-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid