Provider Demographics
NPI:1548609803
Name:JUST KIDS
Entity Type:Organization
Organization Name:JUST KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:631-708-8403
Mailing Address - Street 1:2111 AVALON PINES DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-5146
Mailing Address - Country:US
Mailing Address - Phone:631-708-8403
Mailing Address - Fax:
Practice Address - Street 1:2111 AVALON PINES DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-5146
Practice Address - Country:US
Practice Address - Phone:631-708-8403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475564315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities