Provider Demographics
NPI:1033669296
Name:EARLY INTENSIVE BEHAVIOR INTERVENTION
Entity Type:Organization
Organization Name:EARLY INTENSIVE BEHAVIOR INTERVENTION
Other - Org Name:THE VISTA FOUNDATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CSM
Authorized Official - Prefix:MS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-583-5102
Mailing Address - Street 1:1021 SPRINGBOARD DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-8820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 SPRINGBOARD DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-8820
Practice Address - Country:US
Practice Address - Phone:717-583-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE VISTA FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency