Provider Demographics
NPI:1639425226
Name:KIDS THERAPY AT HOME LLC
Entity Type:Organization
Organization Name:KIDS THERAPY AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:R
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:855-335-5437
Mailing Address - Street 1:203 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-2732
Mailing Address - Country:US
Mailing Address - Phone:855-335-5437
Mailing Address - Fax:254-235-3408
Practice Address - Street 1:6701 SANGER AVE
Practice Address - Street 2:STE. 104
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7737
Practice Address - Country:US
Practice Address - Phone:855-335-5437
Practice Address - Fax:254-235-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health