1245992874 NPI number — KIDZONE THERAPY CENTER

Table of content: (NPI 1245992874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245992874 NPI number — KIDZONE THERAPY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDZONE THERAPY CENTER
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:
KIDZONE THERAPY
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:
1245992874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5335 W. 48TH AVE #500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-865-6042
Provider Business Mailing Address Fax Number:
720-704-4946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5335 W. 48TH AVE #500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-865-6042
Provider Business Practice Location Address Fax Number:
720-704-4946
Provider Enumeration Date:
10/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VIGIL
Authorized Official First Name:
DESIRAE
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
720-232-7135

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9000197723 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com