Provider Demographics
NPI:1518368471
Name:VIP KIDZ LLC
Entity Type:Organization
Organization Name:VIP KIDZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANTILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-486-9513
Mailing Address - Street 1:2500 METROCENTRE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3107
Mailing Address - Country:US
Mailing Address - Phone:561-223-2673
Mailing Address - Fax:561-634-3903
Practice Address - Street 1:2500 METROCENTRE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3107
Practice Address - Country:US
Practice Address - Phone:561-223-2673
Practice Address - Fax:561-634-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60081008261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60081008OtherAGENCY FOR HEALTH CARE ADMINISTRATION