Provider Demographics
NPI:1770771826
Name:PLAY WORK 'N LEARN DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:PLAY WORK 'N LEARN DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/INFANT TODDLER AND FAMILY SPE
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:JACOBS
Authorized Official - Last Name:MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BA, ITFS
Authorized Official - Phone:919-738-7193
Mailing Address - Street 1:1510 SCOTTY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3365
Mailing Address - Country:US
Mailing Address - Phone:919-738-7193
Mailing Address - Fax:919-221-6025
Practice Address - Street 1:1510 SCOTTY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3365
Practice Address - Country:US
Practice Address - Phone:919-738-7193
Practice Address - Fax:919-221-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300034Medicaid