1770365934 NPI number — 4KIDZ KORNER NON-PROFIT CORPORATION

Table of content: SERENA NICOLE LE DO (NPI 1497556658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770365934 NPI number — 4KIDZ KORNER NON-PROFIT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
4KIDZ KORNER NON-PROFIT CORPORATION
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:
1770365934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 SNYDER AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44714-1962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-949-5930
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2335 15TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44706-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-949-5930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
GIVENS
Authorized Official First Name:
SUMMER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PROGRAM DIRECTOR
Authorized Official Telephone Number:
330-949-5930

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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