Provider Demographics
NPI:1447451828
Name:EARLY DEVELOPMENTAL INTERVENTIONS INC
Entity type:Organization
Organization Name:EARLY DEVELOPMENTAL INTERVENTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-233-1544
Mailing Address - Street 1:126 BLACK HAWK RD
Mailing Address - Street 2:
Mailing Address - City:HAPPY
Mailing Address - State:KY
Mailing Address - Zip Code:41746-9053
Mailing Address - Country:US
Mailing Address - Phone:606-233-1544
Mailing Address - Fax:
Practice Address - Street 1:126 BLACK HAWK RD
Practice Address - Street 2:
Practice Address - City:HAPPY
Practice Address - State:KY
Practice Address - Zip Code:41746-9053
Practice Address - Country:US
Practice Address - Phone:606-233-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty