Provider Demographics
NPI:1619313277
Name:123 GO KIDZ
Entity Type:Organization
Organization Name:123 GO KIDZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CBRS PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:BS, ITFS
Authorized Official - Phone:252-342-4043
Mailing Address - Street 1:2339 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-9415
Mailing Address - Country:US
Mailing Address - Phone:252-342-4043
Mailing Address - Fax:888-731-1425
Practice Address - Street 1:2339 SHORE DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-342-4043
Practice Address - Fax:888-731-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health