Provider Demographics
NPI:1679117600
Name:4KIDS HEALTH SERVICES CORP.
Entity Type:Organization
Organization Name:4KIDS HEALTH SERVICES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YARAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELLANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-586-4445
Mailing Address - Street 1:7778 W 2ND CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4308
Mailing Address - Country:US
Mailing Address - Phone:305-586-4445
Mailing Address - Fax:
Practice Address - Street 1:7778 W 2ND CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4308
Practice Address - Country:US
Practice Address - Phone:305-586-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health