Provider Demographics
NPI:1124362819
Name:KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA, INC.
Entity Type:Organization
Organization Name:KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT SPECIALIST II
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-799-8473
Mailing Address - Street 1:4085 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2574
Mailing Address - Country:US
Mailing Address - Phone:610-799-8473
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:2711 BREEZEWOOD AVE FL 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5526
Practice Address - Country:US
Practice Address - Phone:910-223-0949
Practice Address - Fax:910-223-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5146A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5146AOtherLICENSE