Provider Demographics
NPI:1154455616
Name:KIDS ABILITIES, INC
Entity Type:Organization
Organization Name:KIDS ABILITIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:E
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:651-451-3016
Mailing Address - Street 1:490 HIGHWAY 96 W
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1960
Mailing Address - Country:US
Mailing Address - Phone:651-451-3016
Mailing Address - Fax:
Practice Address - Street 1:490 HIGHWAY 96 W
Practice Address - Street 2:SUITE 300
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1960
Practice Address - Country:US
Practice Address - Phone:651-451-3016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275420700Medicaid