Provider Demographics
NPI:1750510822
Name:SUSAN DAVEIRO-COMMUNITY SERVCIES FOR KIDS
Entity Type:Organization
Organization Name:SUSAN DAVEIRO-COMMUNITY SERVCIES FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAVEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-330-1318
Mailing Address - Street 1:104 GASTON DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9460
Mailing Address - Country:US
Mailing Address - Phone:252-330-1318
Mailing Address - Fax:252-330-1318
Practice Address - Street 1:104 GASTON DR
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9460
Practice Address - Country:US
Practice Address - Phone:252-330-1318
Practice Address - Fax:252-330-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency