Provider Demographics
NPI:1992267066
Name:LEE COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Entity type:Organization
Organization Name:LEE COUNTY DISABILITIES AND SPECIAL NEEDS BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUETTA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-484-9473
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:BISHOPVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29010-0468
Mailing Address - Country:US
Mailing Address - Phone:803-484-9473
Mailing Address - Fax:803-484-5710
Practice Address - Street 1:842 MCLEOD RD
Practice Address - Street 2:
Practice Address - City:BISHOPVILLE
Practice Address - State:SC
Practice Address - Zip Code:29010-1100
Practice Address - Country:US
Practice Address - Phone:803-484-9473
Practice Address - Fax:803-484-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency