Provider Demographics
NPI:1750155974
Name:PEDIATRIC EARLY INTERVENTION & DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:PEDIATRIC EARLY INTERVENTION & DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELESLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:843-437-4597
Mailing Address - Street 1:8421 DORCHESTER RD
Mailing Address - Street 2:SUITE 109 PMB 341
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7387
Mailing Address - Country:US
Mailing Address - Phone:843-437-4597
Mailing Address - Fax:
Practice Address - Street 1:3786 LADSON ROAD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456
Practice Address - Country:US
Practice Address - Phone:843-284-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty