1275718389 NPI number — KIDSPEACE NATIONAL CENTERS OF GEORGIA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275718389 NPI number — KIDSPEACE NATIONAL CENTERS OF GEORGIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDSPEACE NATIONAL CENTERS OF GEORGIA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275718389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4085 INDEPENDENCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHNECKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18078-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-799-8343
Provider Business Mailing Address Fax Number:
610-799-8318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 KIDSPEACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30108-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-437-7200
Provider Business Practice Location Address Fax Number:
770-258-9128
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HORAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
EVP/CFO
Authorized Official Telephone Number:
610-799-8552

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  022-672-D , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 848487220A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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