Provider Demographics
NPI:1194414847
Name:EARLY INTERVENTION UPSTATE INC.
Entity type:Organization
Organization Name:EARLY INTERVENTION UPSTATE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:864-909-5260
Mailing Address - Street 1:1077 CORIE CREST DR.
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316
Mailing Address - Country:US
Mailing Address - Phone:864-909-5260
Mailing Address - Fax:864-752-1072
Practice Address - Street 1:1400 BOILING SPEINGS RD SUITE 10
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-909-5260
Practice Address - Fax:864-752-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency