MEDICARE: FOUNDATION FOR POSITIVELY KIDS, A NONPROFIT CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1023530623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION FOR POSITIVELY KIDS, A NONPROFIT CORPORATION

Provider Business Mailing Address
First Line	:	701 N PECOS RD BLDG M
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-2400
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 N PECOS RD BLDG M
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-2400
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:	702-476-9122

Authorized Official
Title or Position	:	COMPLIANCE DIRECTOR
Name	:	FRANCES MALINIS
Credential	:
Telephone Number	:	702-410-7825

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	05/10/2024

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