MEDICARE: FOUNDATION FOR POSITIVELY KIDS

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	251S00000X	Community/Behavioral Health 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	:	1528525391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION FOR POSITIVELY KIDS

Provider Business Mailing Address
First Line	:	2480 E TOMPKINS AVE STE 222
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7625
Country	:	US
Telephone Number	:	702-455-5639
Fax Number	:	702-262-0252

Provider Business Practice Location Address
First Line	:	2480 E TOMPKINS AVE STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7394
Country	:	US
Telephone Number	:	702-262-0037
Fax Number	:	725-204-9970

Authorized Official
Title or Position	:	VICE PRESIDENT OF MEDICAL CLINICS
Name	:	JUDY A NEW
Credential	:
Telephone Number	:	702-455-5639

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	08/11/2021

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Directions to “FOUNDATION FOR POSITIVELY KIDS ” Practice Location

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