Provider Demographics
NPI:1356687222
Name:THE KIDZ CLUB- ST PETE,LLC
Entity Type:Organization
Organization Name:THE KIDZ CLUB- ST PETE,LLC
Other - Org Name:THE KIDZ CLUB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-458-5433
Mailing Address - Street 1:850 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4033
Mailing Address - Country:US
Mailing Address - Phone:727-821-5439
Mailing Address - Fax:727-821-9459
Practice Address - Street 1:1101 HERR LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4301
Practice Address - Country:US
Practice Address - Phone:502-210-5538
Practice Address - Fax:502-327-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29299600603140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003967601Medicaid