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General NPI Number Information
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NPI Number | 1538601679
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Entity Type | Organization
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Legal Business Name | N I A KIDS YOUTH SERVICE ORG., INC
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 901 N POLK ST STE 380
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City | DESOTO
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State | TX
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Zip | 75115-4021
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Country | US
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Telephone | 972-228-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 901 N POLK ST STE 380
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City | DESOTO
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State | TX
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Zip | 75115-4021
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Country | US
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Telephone | 972-228-8381
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LATARA THOMPKINS
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Credential |
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Telephone | 972-228-8381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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