Provider Demographics
NPI:1154876340
Name:JUPITER CHILDREN SERVICES, INC.
Entity type:Organization
Organization Name:JUPITER CHILDREN SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SOFIJA SONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALIC
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF ARTS
Authorized Official - Phone:631-351-1111
Mailing Address - Street 1:3 GREENHILLS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3905
Mailing Address - Country:US
Mailing Address - Phone:631-351-1111
Mailing Address - Fax:
Practice Address - Street 1:3 GREENHILLS RD
Practice Address - Street 2:
Practice Address - City:SOUTH HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11746-3905
Practice Address - Country:US
Practice Address - Phone:631-351-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251C00000XAgenciesDay Training, Developmentally Disabled Services