Provider Demographics
NPI:1720574890
Name:EARLY INTERVENTION ACADEMY, LLC
Entity Type:Organization
Organization Name:EARLY INTERVENTION ACADEMY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-531-2219
Mailing Address - Street 1:8726 SANDY PLAINS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8615
Mailing Address - Country:US
Mailing Address - Phone:813-531-2219
Mailing Address - Fax:
Practice Address - Street 1:8726 SANDY PLAINS DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-8615
Practice Address - Country:US
Practice Address - Phone:813-531-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health