Provider Demographics
NPI:1427038876
Name:KIDS' HARBOR, INC.
Entity Type:Organization
Organization Name:KIDS' HARBOR, INC.
Other - Org Name:KIDS' HARBOR TOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-348-6886
Mailing Address - Street 1:5717 CHAPEL DR.
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065
Mailing Address - Country:US
Mailing Address - Phone:573-348-6886
Mailing Address - Fax:573-348-6887
Practice Address - Street 1:5717 CHAPEL DR.
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065
Practice Address - Country:US
Practice Address - Phone:573-348-6886
Practice Address - Fax:573-348-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206002909Medicaid
MO241989565Medicaid