Provider Demographics
NPI:1144778648
Name:KIDNEXXIONS, LLC
Entity Type:Organization
Organization Name:KIDNEXXIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTE-STROFF
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:618-219-6501
Mailing Address - Street 1:4271 CASTLEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3502
Mailing Address - Country:US
Mailing Address - Phone:618-219-6501
Mailing Address - Fax:
Practice Address - Street 1:4271 CASTLEMAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-3502
Practice Address - Country:US
Practice Address - Phone:618-219-6501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005449251E00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency