Healthcare Provider Details

I. General information

NPI: 1972944718
Provider Name (Legal Business Name): KIDS IN NEED OF SUPPORTIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N SILVER ST
SILVER CITY NM
88061-6779
US

IV. Provider business mailing address

2311 RANCH CLUB RD
SILVER CITY NM
88061-7807
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-2414
  • Fax: 575-388-2457
Mailing address:
  • Phone: 575-388-2414
  • Fax: 575-388-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-08245
License Number StateNM

VIII. Authorized Official

Name: SUSANNE KEE
Title or Position: DIRECTOR
Credential: LISW
Phone: 575-956-7209