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General NPI Number Information
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NPI Number | 1013157833
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Entity Type | Organization
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Legal Business Name | KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA INC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 604 MAGNOLIA DR
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City | ABERDEEN
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State | NC
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Zip | 28315-2202
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Country | US
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Telephone | 910-944-2102
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Fax | 910-944-2175
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Provider Business Mailing Address
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Address Line | 4085 INDEPENDENCE DR
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City | SCHNECKSVILLE
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State | PA
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Zip | 18078-2574
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Country | US
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Telephone | 610-799-8473
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Fax | 610-799-8318
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Authorized Official
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Title or Position | VP FOR MARKETING & BUSINESS DEVELOP
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Name | MICHAEL W SLACK
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Credential |
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Telephone | 610-799-8405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5146A
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License Number State | NC
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