Provider Demographics
NPI:1851169148
Name:KIDS CENTRAL, INC.
Entity Type:Organization
Organization Name:KIDS CENTRAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-873-6332
Mailing Address - Street 1:901 INDUSTRIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4707
Mailing Address - Country:US
Mailing Address - Phone:352-873-6332
Mailing Address - Fax:
Practice Address - Street 1:901 INDUSTRIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4707
Practice Address - Country:US
Practice Address - Phone:352-873-6332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty