Provider Demographics
NPI:1689048480
Name:REBECCA EARLY INTERVENTION SERVICES
Entity Type:Organization
Organization Name:REBECCA EARLY INTERVENTION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL INTERVENTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-928-4259
Mailing Address - Street 1:4437 BLUE RIBBON DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8395
Mailing Address - Country:US
Mailing Address - Phone:606-928-4259
Mailing Address - Fax:
Practice Address - Street 1:4437 BLUE RIBBON DR
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-8395
Practice Address - Country:US
Practice Address - Phone:606-928-4259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency