Provider Demographics
NPI:1821612839
Name:INGENIOUS KIDS CORP.
Entity Type:Organization
Organization Name:INGENIOUS KIDS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUSLEIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-470-9105
Mailing Address - Street 1:820 SPRING LAKE SQ
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1338
Mailing Address - Country:US
Mailing Address - Phone:863-323-0334
Mailing Address - Fax:863-323-0422
Practice Address - Street 1:820 SPRING LAKE SQ
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-1338
Practice Address - Country:US
Practice Address - Phone:863-323-0334
Practice Address - Fax:863-323-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty