Provider Demographics
NPI:1306193172
Name:SEASIDE EARLY CHILDHOOD & INCLUSION SERVICES
Entity Type:Organization
Organization Name:SEASIDE EARLY CHILDHOOD & INCLUSION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BS ITFS
Authorized Official - Phone:508-237-9349
Mailing Address - Street 1:304 COUNTRY HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-9184
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:304 COUNTRY HAVEN DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-9184
Practice Address - Country:US
Practice Address - Phone:508-237-9349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency