Provider Demographics
NPI:1598182172
Name:FOUNDATION FOR POSITIVELY KIDS
Entity Type:Organization
Organization Name:FOUNDATION FOR POSITIVELY KIDS
Other - Org Name:FOUNDATION FOR POSITIVELY KIDS, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT MEDICAL CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-455-5639
Mailing Address - Street 1:2480 E TOMPKINS AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7625
Mailing Address - Country:US
Mailing Address - Phone:702-262-0037
Mailing Address - Fax:702-262-0252
Practice Address - Street 1:2480 E TOMPKINS AVE STE 222
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7625
Practice Address - Country:US
Practice Address - Phone:702-262-0037
Practice Address - Fax:702-262-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5551HHA-5251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5551HHA-5OtherSTATE OF NEVADA, DEPT OF HEATHAND HUMAN SERVICES, DIVISION OF PUBLIC AND BEHAVIO