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NPI Code Detail

MEDICARE: KIDS TURF ACADEMY II, LLC

MEDICARE: KIDS TURF ACADEMY II, LLC
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
1302F00000XExclusive Provider Organization20000108590101NV

General Provider Information

NPI Number : 1194955096
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS TURF ACADEMY II, LLC
Provider Business Mailing Address
First Line : 1380 E SILVERADO RANCH BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-5924
Country : US
Telephone Number : 702-453-8877
Fax Number : 702-453-8874
Provider Business Practice Location Address
First Line : 1380 E SILVERADO RANCH BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89183-5924
Country : US
Telephone Number : 702-453-8877
Fax Number : 702-453-8874
Authorized Official
Title or Position : DIRECTOR
Name : MRS. CONNIE LINNETTE HARRIS
Credential :
Telephone Number : 702-491-1265
Provider Enumeration Date : 07/27/2009
Last Update Date : 07/27/2009

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Directions to “KIDS TURF ACADEMY II, LLC ” Practice Location

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