Provider Demographics
NPI:1194032656
Name:KIDANGO
Entity Type:Organization
Organization Name:KIDANGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-565-0837
Mailing Address - Street 1:44000 OLD WARM SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6145
Mailing Address - Country:US
Mailing Address - Phone:510-565-0837
Mailing Address - Fax:
Practice Address - Street 1:44000 OLD WARM SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6145
Practice Address - Country:US
Practice Address - Phone:510-565-0837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252Y00000X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency