Provider Demographics
NPI:1346951738
Name:EARLY INTERVENTION FOR LITTLE LLC
Entity Type:Organization
Organization Name:EARLY INTERVENTION FOR LITTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIBROOKE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULLIVAN WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-537-5600
Mailing Address - Street 1:7891 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BONNIEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42713-8308
Mailing Address - Country:US
Mailing Address - Phone:270-537-5600
Mailing Address - Fax:
Practice Address - Street 1:7891 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BONNIEVILLE
Practice Address - State:KY
Practice Address - Zip Code:42713-8308
Practice Address - Country:US
Practice Address - Phone:270-537-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency