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General NPI Number Information
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NPI Number | 1720372808
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOR POSITIVELY KIDS
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 2480 E TOMPKINS AVE STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89121-5466
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Country | US
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Telephone | 702-262-0037
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Fax | 702-262-0252
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Provider Business Mailing Address
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Address Line | 2480 E TOMPKINS AVE STE 222
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City | LAS VEGAS
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State | NV
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Zip | 89121-7625
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Country | US
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Telephone | 702-262-0037
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Fax | 702-262-0252
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Authorized Official
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Title or Position | VICE PRESIDENT MEDICAL CLINICS
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Name | JUDY A NEW
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Credential |
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Telephone | 702-455-5639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | NV1172
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License Number State | NV
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