=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326602319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANDS ON DEVELOPMENTAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2019
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 BRIARCLIFF RD
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-804-6215
-----------------------------------------------------
Fax | 864-804-6238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1342
-----------------------------------------------------
City | ROEBUCK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29376-1342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-804-6215
-----------------------------------------------------
Fax | 864-804-6238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/OWNER
-----------------------------------------------------
Name | ELOISE W PEA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-612-3412
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------