Provider Demographics
NPI:1558420018
Name:THE KIDS WORKSHOP INC
Entity Type:Organization
Organization Name:THE KIDS WORKSHOP INC
Other - Org Name:THE KID'S WORKSHOP INC, KIDS WORKSHOP INC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:GREEN
Authorized Official - Last Name:CANADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-449-2099
Mailing Address - Street 1:5901 BEATTIES FORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216
Mailing Address - Country:US
Mailing Address - Phone:704-399-4045
Mailing Address - Fax:704-399-4089
Practice Address - Street 1:THE KIDS WORKSHOP INC
Practice Address - Street 2:5901 BEATTIES FORD ROAD
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216
Practice Address - Country:US
Practice Address - Phone:704-399-4045
Practice Address - Fax:704-399-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409380Medicaid