Provider Demographics
NPI:1740927763
Name:INDEPENDENT KIDS CO
Entity type:Organization
Organization Name:INDEPENDENT KIDS CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:XAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-918-4687
Mailing Address - Street 1:9828 MAIDENFAIR CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5530
Mailing Address - Country:US
Mailing Address - Phone:702-919-4686
Mailing Address - Fax:
Practice Address - Street 1:5625 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1854
Practice Address - Country:US
Practice Address - Phone:702-845-2265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385H00000XRespite Care FacilityRespite Care