MEDICARE: KIDS FIRST FOUNDATION

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	374601367	CA

General Provider Information

NPI Number	:	1063653939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS FIRST FOUNDATION

Provider Business Mailing Address
First Line	:	993C S SANTA FE AVE STE 50
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-631-7550
Fax Number	:	760-630-5248

Provider Business Practice Location Address
First Line	:	993C S SANTA FE AVE STE 50
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-631-7550
Fax Number	:	760-630-5248

Authorized Official
Title or Position	:	CEO
Name	:	MR. IHAB SHAWAHI
Credential	:
Telephone Number	:	760-631-7550

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	03/23/2009

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Directions to “KIDS FIRST FOUNDATION ” Practice Location

Language	Start Address	Practice Location

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