Provider Demographics
NPI:1568837219
Name:PRECIOUS KIDS THERAPY CENTER, INC
Entity Type:Organization
Organization Name:PRECIOUS KIDS THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-910-3247
Mailing Address - Street 1:3507 LEE BLVD
Mailing Address - Street 2:SUITE 277
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971
Mailing Address - Country:US
Mailing Address - Phone:305-910-3247
Mailing Address - Fax:
Practice Address - Street 1:2109 NW 16 TERRACE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-910-3247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health