1386705580 NPI number — FOUNDATION FOR POSITIVELY KIDS

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 1386705580 NPI number — FOUNDATION FOR POSITIVELY KIDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATION FOR POSITIVELY KIDS
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:
POSITIVELY KIDS HOME CARE SERVICES
Provider Other Organization Name Type Code:
3
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:
1386705580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2480 E TOMPKINS AVE STE 222
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89121-7625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-455-5639
Provider Business Mailing Address Fax Number:
702-262-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N PECOS RD
Provider Second Line Business Practice Location Address:
BLDG M
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89101-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-262-0037
Provider Business Practice Location Address Fax Number:
702-262-0252
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEW
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT MEDICAL CLINICS
Authorized Official Telephone Number:
702-455-5639

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100503219 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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