=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962367581
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1111 A BABY'S WISH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2025
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 447 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-719-1606
-----------------------------------------------------
Fax | 833-354-0977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 447 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-2562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-719-1606
-----------------------------------------------------
Fax | 833-354-0977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.E.O/FOUNDER
-----------------------------------------------------
Name | MRS. LYNETTE BRITTANY MILLS-NEVILLS
-----------------------------------------------------
Credential | MSFP
-----------------------------------------------------
Telephone | 917-727-0799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------