Healthcare Provider Details

I. General information

NPI: 1386705580
Provider Name (Legal Business Name): FOUNDATION FOR POSITIVELY KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 LAS VEGAS BLVD N STE 10
LAS VEGAS NV
89115-0587
US

IV. Provider business mailing address

4375 LAS VEGAS BLVD N STE 10
LAS VEGAS NV
89115-0587
US

V. Phone/Fax

Practice location:
  • Phone: 702-262-0037
  • Fax: 702-272-2421
Mailing address:
  • Phone: 702-262-0037
  • Fax: 702-272-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEANETTE SMITH
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 702-262-0037