Provider Demographics
NPI:1720123144
Name:KIDSPEACE NATIONAL CENTERS INC
Entity Type:Organization
Organization Name:KIDSPEACE NATIONAL CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-799-7517
Mailing Address - Street 1:4085 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078
Mailing Address - Country:US
Mailing Address - Phone:800-854-3123
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:101 PITTSTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1150
Practice Address - Country:US
Practice Address - Phone:800-854-3123
Practice Address - Fax:610-799-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA206210251J00000X
PA202550253J00000X
PA239120253J00000X
PA206170253J00000X
PA239110253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100763290-0104Medicaid
PA100763290-0094Medicaid