Provider Demographics
NPI:1407889850
Name:THERAPEUTIC INTERVENTION SERVICES FOR CHILDREN, INC.
Entity Type:Organization
Organization Name:THERAPEUTIC INTERVENTION SERVICES FOR CHILDREN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:JEANNETTE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:336-282-6222
Mailing Address - Street 1:1802 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3120
Mailing Address - Country:US
Mailing Address - Phone:336-282-6222
Mailing Address - Fax:336-282-5723
Practice Address - Street 1:1802 CARMEL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-3120
Practice Address - Country:US
Practice Address - Phone:336-282-6222
Practice Address - Fax:336-282-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9058225100000X
NC6001225100000X
NC1686225100000X
NC5161225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210852Medicaid