Provider Demographics
NPI:1710266093
Name:KIDDIELAND CHILD DEVELOPMENT CENTER INC.
Entity Type:Organization
Organization Name:KIDDIELAND CHILD DEVELOPMENT CENTER INC.
Other - Org Name:ALTERNATIVE CONCEPTS INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-487-7005
Mailing Address - Street 1:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:EARL
Mailing Address - State:NC
Mailing Address - Zip Code:28038-0556
Mailing Address - Country:US
Mailing Address - Phone:704-747-3019
Mailing Address - Fax:704-482-1401
Practice Address - Street 1:5408 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8735
Practice Address - Country:US
Practice Address - Phone:704-747-3019
Practice Address - Fax:704-482-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty