Provider Demographics
NPI:1720376734
Name:EARLY STAGES FOR EARLY AGES INC.
Entity Type:Organization
Organization Name:EARLY STAGES FOR EARLY AGES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENNAY
Authorized Official - Middle Name:ANN TONJA
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:954-849-1117
Mailing Address - Street 1:203 SW 85TH TERR. APT. 306
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-849-1117
Mailing Address - Fax:
Practice Address - Street 1:203 SW 85TH TERR. APT. 306
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-849-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty