Provider Demographics
NPI:1396207940
Name:GREAT KIDS PLACE, LLC
Entity Type:Organization
Organization Name:GREAT KIDS PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-224-1028
Mailing Address - Street 1:21 PINE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3130
Mailing Address - Country:US
Mailing Address - Phone:973-586-8396
Mailing Address - Fax:
Practice Address - Street 1:21 PINE ST STE 205
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3130
Practice Address - Country:US
Practice Address - Phone:973-586-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty