1255654687 NPI number — KOLCHINS/THOMAS INFANT DEVELOPMENT SERVICES, 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 1255654687 NPI number — KOLCHINS/THOMAS INFANT DEVELOPMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOLCHINS/THOMAS INFANT DEVELOPMENT SERVICES, 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:
6
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:
1255654687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26560 AGOURA RD
Provider Second Line Business Mailing Address:
110-B
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-1926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-880-1260
Provider Business Mailing Address Fax Number:
818-880-1360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26560 AGOURA RD
Provider Second Line Business Practice Location Address:
110-B
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302-1926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-880-1260
Provider Business Practice Location Address Fax Number:
818-880-1360
Provider Enumeration Date:
03/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COORDINATOR/OWNER
Authorized Official Telephone Number:
818-880-1260

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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