Healthcare Provider Details

I. General information

NPI: 1265485205
Provider Name (Legal Business Name): K & S CHILDHOOD DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 MARTIN LUTHER KING JR DR
MONROE LA
71203-5360
US

IV. Provider business mailing address

PO BOX 4327
MONROE LA
71211-4327
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-4953
  • Fax: 318-388-7650
Mailing address:
  • Phone: 318-388-4953
  • Fax: 318-388-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. GLORIA C. DIXON
Title or Position: OWNER
Credential:
Phone: 318-388-4953