Provider Demographics
NPI:1477311371
Name:KIDS INDIVIDUAL DEVELOPMENT SERVICES LLC
Entity Type:Organization
Organization Name:KIDS INDIVIDUAL DEVELOPMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:458-802-5080
Mailing Address - Street 1:922 NW CIRCLE BLVD STE 160-112
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1483
Mailing Address - Country:US
Mailing Address - Phone:541-253-2115
Mailing Address - Fax:541-275-0228
Practice Address - Street 1:528 COTTAGE ST NE STE 400
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3861
Practice Address - Country:US
Practice Address - Phone:623-321-2811
Practice Address - Fax:541-275-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDZ1325Medicaid