MEDICARE: KID CONNECTIONS, INC

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	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215136932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KID CONNECTIONS, INC

Provider Business Mailing Address
First Line	:	4383 W 49TH S
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-5726
Country	:	US
Telephone Number	:	208-528-6051
Fax Number	:

Provider Business Practice Location Address
First Line	:	4383 W 49TH S
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83402-5726
Country	:	US
Telephone Number	:	208-528-6051
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER/OWNER
Name	:	MS. SARAH LYNN RUSSELL
Credential	:	LSW
Telephone Number	:	208-528-6051

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/12/2007

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Directions to “KID CONNECTIONS, INC ” Practice Location

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