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NPI Code Detail

MEDICARE: KIDEOLOGY, LTD

MEDICARE: KIDEOLOGY, LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider AgencyNV20111674178NV

General Provider Information

NPI Number : 1063789105
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDEOLOGY, LTD
Provider Business Mailing Address
First Line : 5120 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2305
Country : US
Telephone Number : 702-508-0908
Fax Number : 702-508-9208
Provider Business Practice Location Address
First Line : 5120 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-2305
Country : US
Telephone Number : 702-508-0908
Fax Number : 702-508-9208
Authorized Official
Title or Position : MANAGING MEMBER
Name : SARAH CWIAK
Credential : DPT
Telephone Number : 702-508-0908
Provider Enumeration Date : 11/17/2011
Last Update Date : 11/26/2011

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