Provider Demographics
NPI:1366674210
Name:ADVANCE KIDS
Entity Type:Organization
Organization Name:ADVANCE KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-363-6103
Mailing Address - Street 1:9755 LINCOLN VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-3334
Mailing Address - Country:US
Mailing Address - Phone:916-363-6103
Mailing Address - Fax:
Practice Address - Street 1:9755 LINCOLN VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3334
Practice Address - Country:US
Practice Address - Phone:916-363-6103
Practice Address - Fax:916-244-0594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty