Provider Demographics
NPI:1265485205
Name:K & S CHILDHOOD DEVELOPMENT
Entity Type:Organization
Organization Name:K & S CHILDHOOD DEVELOPMENT
Other - Org Name:K & S PCA/SIL, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-388-4953
Mailing Address - Street 1:PO BOX 4327
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-4327
Mailing Address - Country:US
Mailing Address - Phone:318-388-4953
Mailing Address - Fax:318-388-7650
Practice Address - Street 1:611 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-5360
Practice Address - Country:US
Practice Address - Phone:318-388-4953
Practice Address - Fax:318-388-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1478474Medicaid