Healthcare Provider Details

I. General information

NPI: 1700534765
Provider Name (Legal Business Name): POPPY CHILDREN'S CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE B
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

784 S CLEARWATER LOOP STE B
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 630-240-4437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA IMGRUND
Title or Position: CO-OWNER
Credential: MA
Phone: 630-240-4437