=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528566775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS FOR ABATHERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2018
-----------------------------------------------------
Last Update Date | 01/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12039 SW 132ND CT UNIT 28-2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-252-6783
-----------------------------------------------------
Fax | 305-252-6784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12039 SW 132ND CT UNIT 28-2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-4785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-252-6783
-----------------------------------------------------
Fax | 305-252-6784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YOHAN U PENARANDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-252-6783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------