Provider Demographics
NPI:1982653580
Name:KID BUILDERS, LLC.
Entity Type:Organization
Organization Name:KID BUILDERS, LLC.
Other - Org Name:REHAB BUILDERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:KAZON
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:864-907-7725
Mailing Address - Street 1:6 BOX TREE WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5964
Mailing Address - Country:US
Mailing Address - Phone:864-907-7725
Mailing Address - Fax:864-236-9935
Practice Address - Street 1:6 BOX TREE WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5964
Practice Address - Country:US
Practice Address - Phone:864-907-7725
Practice Address - Fax:864-236-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4386Medicaid