Provider Demographics
NPI:1225076904
Name:KIDS DC, LLC
Entity Type:Organization
Organization Name:KIDS DC, LLC
Other - Org Name:KIDS DEVELOPMENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DINN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:713-774-5437
Mailing Address - Street 1:8021 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5200
Mailing Address - Country:US
Mailing Address - Phone:713-774-5437
Mailing Address - Fax:713-774-5445
Practice Address - Street 1:8021 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5200
Practice Address - Country:US
Practice Address - Phone:713-774-5437
Practice Address - Fax:713-774-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179036201Medicaid
TX179036201Medicaid