Provider Demographics
NPI:1588387526
Name:MYLESTONES EARLY INTERVENTION
Entity type:Organization
Organization Name:MYLESTONES EARLY INTERVENTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLING
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, BCBA
Authorized Official - Phone:209-884-2424
Mailing Address - Street 1:1457 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7000
Mailing Address - Country:US
Mailing Address - Phone:209-884-2424
Mailing Address - Fax:
Practice Address - Street 1:515 13TH ST # 108
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2437
Practice Address - Country:US
Practice Address - Phone:209-884-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities