Provider Demographics
NPI:1114189420
Name:JUST 4 KIDZ THERAPY, LLC
Entity Type:Organization
Organization Name:JUST 4 KIDZ THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O
Authorized Official - Prefix:MR
Authorized Official - First Name:CHADDRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-283-3100
Mailing Address - Street 1:1801 N HAMPTON RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2391
Mailing Address - Country:US
Mailing Address - Phone:972-283-3100
Mailing Address - Fax:972-283-3125
Practice Address - Street 1:1801 N HAMPTON RD
Practice Address - Street 2:SUITE 350
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2391
Practice Address - Country:US
Practice Address - Phone:972-283-3100
Practice Address - Fax:972-283-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110553251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181975501Medicaid
TX178849901Medicaid
TX182122501Medicaid