Provider Demographics
NPI:1528692670
Name:HIGH 5 EARLY INTERVENTION SERVICES
Entity type:Organization
Organization Name:HIGH 5 EARLY INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:NIKITA
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-479-4141
Mailing Address - Street 1:156 RYE LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5301
Mailing Address - Country:US
Mailing Address - Phone:910-479-4141
Mailing Address - Fax:
Practice Address - Street 1:156 RYE LN
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5301
Practice Address - Country:US
Practice Address - Phone:910-479-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health