Provider Demographics
NPI:1720529647
Name:KOOL KIDS, INC
Entity Type:Organization
Organization Name:KOOL KIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES / OWNER/MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:O'NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:407-963-5638
Mailing Address - Street 1:1050 PLAZA DR STE I
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-4058
Mailing Address - Country:US
Mailing Address - Phone:407-963-5638
Mailing Address - Fax:407-278-4020
Practice Address - Street 1:2342 VICTORIA FALLS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4314
Practice Address - Country:US
Practice Address - Phone:407-963-5638
Practice Address - Fax:407-278-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care