=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174255889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALWAYS HOPE DEVELOPMENTAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 07/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6270 EVAN CIR
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-4398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-387-5693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6270 EVAN CIR
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-4398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-387-5693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ITDS
-----------------------------------------------------
Name | JILL M BALLANTYNE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-387-5693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------