1326284910 NPI number — KIDS CAN, LLC

Table of content: (NPI 1326284910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326284910 NPI number — KIDS CAN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS CAN, LLC
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:
1326284910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 S. SHARON-AMITY ROAD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-2880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-364-4133
Provider Business Mailing Address Fax Number:
704-364-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 S SHARON AMITY RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-2880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-364-4133
Provider Business Practice Location Address Fax Number:
704-364-4134
Provider Enumeration Date:
01/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TIMMONS
Authorized Official First Name:
DAPHNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST/MANAGER OF CORPORATION
Authorized Official Telephone Number:
704-364-4133

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  3216 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 1130 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: C001983 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 6103892 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6000262 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".