Provider Demographics
NPI:1801469085
Name:PATCHWORK KIDS LLC
Entity type:Organization
Organization Name:PATCHWORK KIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-288-1778
Mailing Address - Street 1:2318 HOLSUM CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5901
Mailing Address - Country:US
Mailing Address - Phone:903-233-4395
Mailing Address - Fax:972-584-6117
Practice Address - Street 1:2318 HOLSUM CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5901
Practice Address - Country:US
Practice Address - Phone:903-233-4395
Practice Address - Fax:972-584-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty