Provider Demographics
NPI:1801646047
Name:MILE HIGH KIDS THERAPEUTIC SOLUTIONS
Entity type:Organization
Organization Name:MILE HIGH KIDS THERAPEUTIC SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARDELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DHA
Authorized Official - Phone:757-962-8005
Mailing Address - Street 1:2712 SOUTHERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7429
Mailing Address - Country:US
Mailing Address - Phone:757-962-8005
Mailing Address - Fax:
Practice Address - Street 1:2712 SOUTHERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7429
Practice Address - Country:US
Practice Address - Phone:757-962-8005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health