Healthcare Provider Details

I. General information

NPI: 1649814500
Provider Name (Legal Business Name): KIDS OVERCOMING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 OAKRIDGE DR UNIT 105
FORT COLLINS CO
80525-9651
US

IV. Provider business mailing address

PO BOX 399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax: 510-863-9848
Mailing address:
  • Phone: 866-523-4268
  • Fax: 510-863-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TORI BEJAR
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 623-444-2169