Provider Demographics
NPI:1073390399
Name:KIDS' KASTLE LLC
Entity Type:Organization
Organization Name:KIDS' KASTLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERLENCIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-622-4677
Mailing Address - Street 1:586 LAKELAND EAST DR STE A
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9028
Mailing Address - Country:US
Mailing Address - Phone:601-707-7121
Mailing Address - Fax:601-510-9806
Practice Address - Street 1:2359 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4931
Practice Address - Country:US
Practice Address - Phone:601-622-4677
Practice Address - Fax:601-510-9806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care