MEDICARE: KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA 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	251S00000X	Community/Behavioral Health Agency	5146A	NC
2	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	:	1942345731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA INC

Provider Business Mailing Address
First Line	:	4085 INDEPENDENCE DRIVE
Second Line	:
City	:	SCHNECKSVILLE
State	:	PA
Zip	:	18078
Country	:	US
Telephone Number	:	610-799-8543
Fax Number	:	610-799-8318

Provider Business Practice Location Address
First Line	:	3117 POPLARWOOD CT STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-1040
Country	:	US
Telephone Number	:	919-872-6447
Fax Number	:	919-872-6671

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. MICHAEL SLACK
Credential	:
Telephone Number	:	610-799-8405

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	01/02/2025

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