Organization · NPI-2
Carousel Developmental Service
Early Intervention Provider Agency · Pomona, CA
NPI number1275172579
StatusActive
Last updated in NPPESJan 3, 2020
Details
- NPI
- 1275172579
- Entity type
- Organization (NPI-2)
- Legal business name
- Carousel Developmental Service
- Organization subpart
- No
- Enumeration date
- Jan 3, 2020
- Certification date
- Jan 3, 2020
- Last updated
- Jan 3, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 252Y00000X | Early Intervention Provider Agency | – | – | Yes |
Practice location
300 S Park Ave Ste 804Pomona, CA 91766-1559
Phone 909-469-2022
Mailing address
300 S Park Ave Ste 804Pomona, CA 91766-1559
Phone 909-469-2022
Authorized official
Jazmine Blackman
Co-Owner/Director
9094692022
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