Healthcare Provider Details

I. General information

NPI: 1659524395
Provider Name (Legal Business Name): KIDSPEACE NATIONAL CENTERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BROADWAY
BETHLEHEM PA
18015-3904
US

IV. Provider business mailing address

4085 INDEPENDENCE DR
SCHNECKSVILLE PA
18078-2574
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-8119
  • Fax: 610-799-8197
Mailing address:
  • Phone: 800-854-3123
  • Fax: 610-799-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number201990
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number201990
License Number StatePA

VIII. Authorized Official

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