Provider Demographics
NPI:1255979647
Name:SPECTRUM KIDS
Entity type:Organization
Organization Name:SPECTRUM KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUAIL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:605-692-2444
Mailing Address - Street 1:165 AIRPORT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1844
Mailing Address - Country:US
Mailing Address - Phone:605-692-2444
Mailing Address - Fax:
Practice Address - Street 1:165 AIRPORT AVE STE B
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1844
Practice Address - Country:US
Practice Address - Phone:605-692-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency