Provider Demographics
NPI:1003270026
Name:KISS KISSABLE KIDS LLC
Entity Type:Organization
Organization Name:KISS KISSABLE KIDS LLC
Other - Org Name:KISS KISSABLE KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:WINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-744-9518
Mailing Address - Street 1:32461 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4300
Mailing Address - Country:US
Mailing Address - Phone:734-444-9518
Mailing Address - Fax:734-744-9520
Practice Address - Street 1:32461 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4300
Practice Address - Country:US
Practice Address - Phone:734-444-9518
Practice Address - Fax:734-744-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization