Provider Demographics
NPI:1447902564
Name:ELI COLLINS FOUNDATION FOR PREMATURE BABIES
Entity type:Organization
Organization Name:ELI COLLINS FOUNDATION FOR PREMATURE BABIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:SELENE
Authorized Official - Last Name:TISDALE-SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-355-5625
Mailing Address - Street 1:137 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3427
Mailing Address - Country:US
Mailing Address - Phone:843-355-5625
Mailing Address - Fax:843-355-5627
Practice Address - Street 1:137 E MILL ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3427
Practice Address - Country:US
Practice Address - Phone:843-355-5625
Practice Address - Fax:843-355-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency