Provider Demographics
NPI:1821690108
Name:PEEK-A-BOO EARLY INTERVENTION SERVICES, LLC
Entity Type:Organization
Organization Name:PEEK-A-BOO EARLY INTERVENTION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TOMEIKA
Authorized Official - Middle Name:ARDRELL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-817-7112
Mailing Address - Street 1:4975 LACROSS RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-6523
Mailing Address - Country:US
Mailing Address - Phone:843-790-0964
Mailing Address - Fax:
Practice Address - Street 1:4975 LACROSS RD STE 101A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-6523
Practice Address - Country:US
Practice Address - Phone:843-790-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management