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General NPI Number Information
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NPI Number | 1821690108
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Entity Type | Organization
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Legal Business Name | PEEK-A-BOO EARLY INTERVENTION SERVICES, LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 4975 LACROSS RD STE 101A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6523
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Country | US
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Telephone | 843-790-0964
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Fax |
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD STE 101A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6523
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Country | US
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Telephone | 843-790-0964
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MS. TOMEIKA ARDRELL MARTIN
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Credential |
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Telephone | 843-817-7112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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