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General NPI Number Information
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NPI Number | 1851103451
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Entity Type | Organization
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Legal Business Name | KIDDES CROWNED CARE LLC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 44408 W PALO ALISO WAY
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City | MARICOPA
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State | AZ
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Zip | 85138-3467
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Country | US
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Telephone | 602-571-8563
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 N CENTRAL AVE SUITE 183
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City | PHOENIX
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State | AZ
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Zip | 85012
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Country | US
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Telephone | 602-571-8563
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ASHLEE LAUREN KIDDE
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Credential |
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Telephone | 602-571-8563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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