Healthcare Provider Details

I. General information

NPI: 1184205890
Provider Name (Legal Business Name): KIDS CROSSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 COLORADO AVE
LA JUNTA CO
81050-2307
US

IV. Provider business mailing address

1440 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-3502
US

V. Phone/Fax

Practice location:
  • Phone: 719-469-9379
  • Fax:
Mailing address:
  • Phone: 719-632-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WILLIAM LEE OESTERLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 719-510-6659