MEDICARE: KIDS IN DISTRESS

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
1	253J00000X	Foster Care Agency		FL

General Provider Information

NPI Number	:	1427300789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS IN DISTRESS

Provider Business Mailing Address
First Line	:	819 NE 26TH ST
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-1239
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 NE 26TH ST.
Second Line	:
City	:	FT. LAUD
State	:	FL
Zip	:	33305
Country	:	US
Telephone Number	:	954-701-8728
Fax Number	:	561-276-0150

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	KEVIN BOCHENECK
Credential	:	MAMS
Telephone Number	:	954-390-7654

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	07/21/2022

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Directions to “KIDS IN DISTRESS ” Practice Location

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