Provider Demographics
NPI:1811032238
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 DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078
Mailing Address - Country:US
Mailing Address - Phone:610-799-8543
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:5300 KIDSPEACE DRIVE
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069
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:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207050323P00000X, 323P00000X
PA244180323P00000X
PA207000323P00000X
PA206980323P00000X
PA207030323P00000X
PA206950323P00000X
PA220110323P00000X
PA207040323P00000X
PA206960323P00000X
PA207010323P00000X
PA206970323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418658300Medicaid
WY132770400Medicaid
WV0002673000Medicaid
DC047350400Medicaid
NJ8386803Medicaid
PA100763290-0054Medicaid