Provider Demographics
NPI:1720300783
Name:KIDZ KINGDOM PDHC
Entity Type:Organization
Organization Name:KIDZ KINGDOM PDHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:818-554-0927
Mailing Address - Street 1:13022 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-4955
Mailing Address - Country:US
Mailing Address - Phone:818-554-0927
Mailing Address - Fax:626-447-9657
Practice Address - Street 1:13022 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4955
Practice Address - Country:US
Practice Address - Phone:818-554-0927
Practice Address - Fax:626-447-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric