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NPI Code Detail

MEDICARE: KIDS IN NEED OF SUPPORTIVE SERVICES

MEDICARE: KIDS IN NEED OF SUPPORTIVE SERVICES
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1164749164
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS IN NEED OF SUPPORTIVE SERVICES
Provider Business Mailing Address
First Line : 2311 RANCH CLUB RD.
Second Line : PMB 408
City : SILVER CITY
State : NM
Zip : 88061-4627
Country : US
Telephone Number : 575-388-2414
Fax Number : 575-388-2457
Provider Business Practice Location Address
First Line : 610 N SILVER ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-6779
Country : US
Telephone Number : 575-388-2414
Fax Number : 575-388-2457
Authorized Official
Title or Position : DIRECTOR
Name : SUSANNE KEE
Credential : LISW
Telephone Number : 575-956-7209
Provider Enumeration Date : 04/29/2010
Last Update Date : 08/08/2013

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Directions to “KIDS IN NEED OF SUPPORTIVE SERVICES ” Practice Location

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