Healthcare Provider Details

I. General information

NPI: 1134769193
Provider Name (Legal Business Name): 4 KIDS 2 KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA ST
CARPINTERIA CA
93013-1501
US

IV. Provider business mailing address

108 UNIVERSITY AVE
VENTURA CA
93003-3844
US

V. Phone/Fax

Practice location:
  • Phone: 805-340-3517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTA KESSLER
Title or Position: RESIDENTIAL COUNSELOR
Credential:
Phone: 805-340-3517