Healthcare Provider Details

I. General information

NPI: 1841362167
Provider Name (Legal Business Name): KIDSPEACE NATIONAL CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BROADWAY
BETHLEHEM PA
18015
US

IV. Provider business mailing address

4085 INDEPENDENCE DRIVE
SCHNECKSVILLE PA
18078
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number206610
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number212140
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number207350
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number207280
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number221160
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number208140
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