Provider Demographics
NPI:1235506767
Name:DEVELOPMENTAL KIDS CENTER, LLC
Entity Type:Organization
Organization Name:DEVELOPMENTAL KIDS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAUDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-469-9953
Mailing Address - Street 1:8660 W FLAGLER ST
Mailing Address - Street 2:133
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2031
Mailing Address - Country:US
Mailing Address - Phone:786-558-7923
Mailing Address - Fax:786-558-7938
Practice Address - Street 1:8660 W FLAGLER ST
Practice Address - Street 2:133
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2031
Practice Address - Country:US
Practice Address - Phone:786-558-7923
Practice Address - Fax:786-558-7939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty