Provider Demographics
NPI:1700273034
Name:KBC KIDZ LLC
Entity Type:Organization
Organization Name:KBC KIDZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-553-9590
Mailing Address - Street 1:507 OAKHILL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502
Mailing Address - Country:US
Mailing Address - Phone:330-553-9590
Mailing Address - Fax:
Practice Address - Street 1:445 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4846
Practice Address - Country:US
Practice Address - Phone:330-553-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health