Provider Demographics
NPI:1699339168
Name:PALMETTO EARLY INTERVENTION SERVICE
Entity type:Organization
Organization Name:PALMETTO EARLY INTERVENTION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-237-8112
Mailing Address - Street 1:124 BAY TREE CT
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-5923
Mailing Address - Country:US
Mailing Address - Phone:864-237-8112
Mailing Address - Fax:864-751-6389
Practice Address - Street 1:350 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4637
Practice Address - Country:US
Practice Address - Phone:864-237-8112
Practice Address - Fax:864-751-6389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency