Provider Demographics
NPI:1255654687
Name:KOLCHINS/THOMAS INFANT DEVELOPMENT SERVICES, INC.
Entity type:Organization
Organization Name:KOLCHINS/THOMAS INFANT DEVELOPMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-880-1260
Mailing Address - Street 1:26560 AGOURA RD
Mailing Address - Street 2:110-B
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1926
Mailing Address - Country:US
Mailing Address - Phone:818-880-1260
Mailing Address - Fax:818-880-1360
Practice Address - Street 1:26560 AGOURA RD
Practice Address - Street 2:110-B
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1926
Practice Address - Country:US
Practice Address - Phone:818-880-1260
Practice Address - Fax:818-880-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency