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General NPI Number Information
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NPI Number | 1376000158
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Entity Type | Organization
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Legal Business Name | KIDDIE KOACH PRP LLC.
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Dates
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Enumeration Date | 02/27/2019
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 9922 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1804
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Country | US
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Telephone | 443-657-3345
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Fax |
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Provider Business Mailing Address
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Address Line | 9922 LIBERTY RD
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-1804
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Country | US
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Telephone | 443-657-3345
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | NICOLE PRICE
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Credential |
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Telephone | 443-657-3345
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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 |
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License Number State |
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