Provider Demographics
NPI:1235795675
Name:SMART START EARLY INTERVENTION, LLC
Entity Type:Organization
Organization Name:SMART START EARLY INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-439-7305
Mailing Address - Street 1:2275 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-8441
Mailing Address - Country:US
Mailing Address - Phone:843-439-7305
Mailing Address - Fax:843-528-1717
Practice Address - Street 1:2275 SALEM RD
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-8441
Practice Address - Country:US
Practice Address - Phone:843-439-7305
Practice Address - Fax:843-528-1717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency