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NPI Code Detail

MEDICARE: KIDS' HARBOR, INC.

MEDICARE: KIDS' HARBOR, 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
1251V00000XVoluntary or Charitable Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427038876
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDS' HARBOR, INC.
Provider Business Mailing Address
First Line : 5717 CHAPEL DR.
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065
Country : US
Telephone Number : 573-348-6886
Fax Number : 573-348-6887
Provider Business Practice Location Address
First Line : 5717 CHAPEL DR.
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065
Country : US
Telephone Number : 573-348-6886
Fax Number : 573-348-6887
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MRS. CARA GERDIMAN
Credential :
Telephone Number : 573-348-6886
Provider Enumeration Date : 01/20/2006
Last Update Date : 08/10/2011

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Directions to “KIDS' HARBOR, INC. ” Practice Location

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