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General NPI Number Information
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NPI Number | 1629876438
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Entity Type | Organization
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Legal Business Name | KIDZ CORNER CLUBHOUSE
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 609 MONTANA STREET
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City | CLEARWATER
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State | NE
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Zip | 68726-0085
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Country | US
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Telephone | 402-841-5706
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Fax |
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Provider Business Mailing Address
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Address Line | 85596 516TH AVE
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City | CLEARWATER
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State | NE
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Zip | 68726-5338
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Country | US
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Telephone | 402-841-5706
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA MARIE FLETCHER
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Credential |
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Telephone | 402-841-5706
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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