Provider Demographics
NPI:1659461119
Name:FOR KIDS ONLY CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:FOR KIDS ONLY CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-754-7777
Mailing Address - Street 1:PO BOX 2991
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-2991
Mailing Address - Country:US
Mailing Address - Phone:910-754-7777
Mailing Address - Fax:910-755-7777
Practice Address - Street 1:344 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28459
Practice Address - Country:US
Practice Address - Phone:910-754-7777
Practice Address - Fax:910-755-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1055054251B00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300972BMedicaid
NC8300972KMedicaid
NC8300972Medicaid