Healthcare Provider Details

I. General information

NPI: 1255536363
Provider Name (Legal Business Name): KIDSPEACE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 BENOIST FARMS ROAD
WEST PALM BEACH FL
33411
US

IV. Provider business mailing address

4085 INDEPENDENCE DRIVE
SCHNECKSVILLE PA
18078
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7451
  • Fax: 407-862-2737
Mailing address:
  • Phone: 610-799-8543
  • Fax: 610-799-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL W SLACK
Title or Position: VP FOR MARKETING AND BUSINESS DEVEL
Credential:
Phone: 610-799-8405