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General NPI Number Information
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NPI Number | 1467573220
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Entity Type | Organization
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Legal Business Name | KIDZ ARK, INC.
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17282 COUNTY ROAD 32
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City | STERLING
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State | CO
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Zip | 80751-9420
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Country | US
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Telephone | 970-522-5775
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Fax | 970-522-5983
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Provider Business Mailing Address
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Address Line | PO BOX 1725
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City | STERLING
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State | CO
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Zip | 80751-1725
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Country | US
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Telephone | 970-522-5775
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Fax | 970-522-5983
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JANA WELSH
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Credential | RN
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Telephone | 970-522-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 34340
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License Number State | CO
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