Healthcare Provider Details

I. General information

NPI: 1487894200
Provider Name (Legal Business Name): KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 BOONE TRAIL EXT STE H
FAYETTEVILLE NC
28304-3860
US

IV. Provider business mailing address

4085 INDEPENDENCE DR
SCHNECKSVILLE PA
18078-2574
US

V. Phone/Fax

Practice location:
  • Phone: 910-223-0949
  • Fax: 910-223-9626
Mailing address:
  • Phone: 610-799-8343
  • Fax: 610-799-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL SLACK
Title or Position: PRESIDENT & CEO
Credential:
Phone: 610-799-8405