Healthcare Provider Details

I. General information

NPI: 1407312689
Provider Name (Legal Business Name): 4 KIDS 2 KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA STREET
CAPINTERIA CA
93013
US

IV. Provider business mailing address

1483 ALVA STREET
CAPINTERIA CA
93013
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0299
  • Fax: 805-566-0298
Mailing address:
  • Phone: 805-566-0299
  • Fax: 805-566-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE LOUISE HART
Title or Position: C.E.O.
Credential:
Phone: 805-573-0752