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General NPI Number Information
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NPI Number | 1902135791
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Entity Type | Organization
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Legal Business Name | THE EARLY INTERVENTION CENTER
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 18300 W 12 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2670
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Country | US
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Telephone | 248-559-5820
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Fax | 248-559-5822
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Provider Business Mailing Address
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Address Line | 32500 TELEGRAPH RD SUITE 209
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City | BINGHAM FARMS
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State | MI
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Zip | 48025-2461
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Country | US
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Telephone | 248-988-9356
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Fax | 248-723-3341
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Authorized Official
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Title or Position | ACCOUNTANT
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Name | KRIS ROSE
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Credential |
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Telephone | 248-988-9356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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