Provider Demographics
NPI:1902135791
Name:THE EARLY INTERVENTION CENTER
Entity Type:Organization
Organization Name:THE EARLY INTERVENTION CENTER
Other - Org Name:THE EIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-988-9356
Mailing Address - Street 1:32500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2461
Mailing Address - Country:US
Mailing Address - Phone:248-988-9356
Mailing Address - Fax:248-723-3341
Practice Address - Street 1:18300 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2670
Practice Address - Country:US
Practice Address - Phone:248-559-5820
Practice Address - Fax:248-559-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty