Provider Demographics
NPI:1790328466
Name:CONNECTED KIDZ, LLC
Entity Type:Organization
Organization Name:CONNECTED KIDZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATION THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JURADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-620-9702
Mailing Address - Street 1:1803 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1189
Mailing Address - Country:US
Mailing Address - Phone:803-620-9702
Mailing Address - Fax:803-620-9722
Practice Address - Street 1:1803 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1189
Practice Address - Country:US
Practice Address - Phone:803-620-9702
Practice Address - Fax:803-620-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1347Medicaid
SCGP9395Medicaid