Healthcare Provider Details

I. General information

NPI: 1851424253
Provider Name (Legal Business Name): KIDSPEACE NATIONAL CENTERS OF NEW ENGLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ALFRED ROAD PARK ONE ELEVEN
BIDDEFORD ME
04005
US

IV. Provider business mailing address

4085 INDEPENDENCE DRIVE
SCHENECKSVILLE PA
18078
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-4976
  • Fax: 207-284-4629
Mailing address:
  • Phone: 800-854-3123
  • Fax: 610-799-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number322081
License Number StateME

VIII. Authorized Official

Name: MR. MICHAEL W SLACK
Title or Position: VP FOR MARKETING AND BUSINESS DEVEL
Credential:
Phone: 800-854-3123