Provider Demographics
NPI:1609029172
Name:KIDS 4 SUCCESS, LLC
Entity Type:Organization
Organization Name:KIDS 4 SUCCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TELOVE
Authorized Official - Middle Name:LADAWN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-818-4352
Mailing Address - Street 1:641 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-1719
Mailing Address - Country:US
Mailing Address - Phone:754-246-8506
Mailing Address - Fax:
Practice Address - Street 1:641 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1719
Practice Address - Country:US
Practice Address - Phone:754-246-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1052-14-001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness