Provider Demographics
NPI:1679736656
Name:COLLEGE INTERNSHIP PROGRAM, INC.
Entity Type:Organization
Organization Name:COLLEGE INTERNSHIP PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-259-1900
Mailing Address - Street 1:3716 N WICKHAM RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2324
Mailing Address - Country:US
Mailing Address - Phone:321-259-1900
Mailing Address - Fax:321-259-1907
Practice Address - Street 1:3716 N WICKHAM RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2324
Practice Address - Country:US
Practice Address - Phone:321-259-1900
Practice Address - Fax:321-259-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities