Provider Demographics
NPI:1437212024
Name:KIDS KLUB, INC.
Entity Type:Organization
Organization Name:KIDS KLUB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RN
Authorized Official - Phone:401-723-2277
Mailing Address - Street 1:462 SMITHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2552
Mailing Address - Country:US
Mailing Address - Phone:401-723-2277
Mailing Address - Fax:401-475-4832
Practice Address - Street 1:462 SMITHFIELD AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2552
Practice Address - Country:US
Practice Address - Phone:401-723-2277
Practice Address - Fax:401-475-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty