Provider Demographics
NPI:1104641489
Name:KIDS INDIVIDUAL DEVELOPMENT SERVICES HI LLC
Entity type:Organization
Organization Name:KIDS INDIVIDUAL DEVELOPMENT SERVICES HI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-253-2115
Mailing Address - Street 1:922 NW CIRCLE BLVD STE 160-112
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1483
Mailing Address - Country:US
Mailing Address - Phone:541-253-2115
Mailing Address - Fax:
Practice Address - Street 1:1001 BISHOP ST STE 2685A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3404
Practice Address - Country:US
Practice Address - Phone:623-321-2811
Practice Address - Fax:541-275-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care