Healthcare Provider Details

I. General information

NPI: 1659461119
Provider Name (Legal Business Name): FOR KIDS ONLY CHILD DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 MULBERRY ST
SHALLOTTE NC
28459
US

IV. Provider business mailing address

PO BOX 2991
SHALLOTTE NC
28459-2991
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-7777
  • Fax: 910-755-7777
Mailing address:
  • Phone: 910-754-7777
  • Fax: 910-755-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1055054
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1055054
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1055054
License Number StateNC

VIII. Authorized Official

Name: MRS. PAMELA L HELMS
Title or Position: OWNER ADMINISTRATOR
Credential:
Phone: 910-754-7777