Provider Demographics
NPI:1265851877
Name:SPECIAL K ENRICHMENT, INC.
Entity Type:Organization
Organization Name:SPECIAL K ENRICHMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:QP, MBA
Authorized Official - Phone:704-395-9387
Mailing Address - Street 1:PO BOX 668882
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-8882
Mailing Address - Country:US
Mailing Address - Phone:704-395-9387
Mailing Address - Fax:704-395-9436
Practice Address - Street 1:1118 PONDELLA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5939
Practice Address - Country:US
Practice Address - Phone:704-395-9387
Practice Address - Fax:704-395-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409000Medicaid