Healthcare Provider Details

I. General information

NPI: 1497855100
Provider Name (Legal Business Name): KLINE DEVELOPMENTAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 04/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 MEREDITH DR
PENSACOLA FL
32504-4752
US

IV. Provider business mailing address

2986 MEREDITH DR
PENSACOLA FL
32504-4752
US

V. Phone/Fax

Practice location:
  • Phone: 850-572-5108
  • Fax: 850-474-3940
Mailing address:
  • Phone: 850-572-5108
  • Fax: 850-474-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number688059298
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number688059296
License Number StateFL

VIII. Authorized Official

Name: MRS. DEBRA KLINE
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 850-572-5108