Provider Demographics
NPI:1104693035
Name:KINDER CUB SCHOOL, INC
Entity type:Organization
Organization Name:KINDER CUB SCHOOL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-498-0002
Mailing Address - Street 1:149 NE 221ST AVE
Mailing Address - Street 2:
Mailing Address - City:CROSS CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32628-5663
Mailing Address - Country:US
Mailing Address - Phone:352-498-0002
Mailing Address - Fax:352-498-0033
Practice Address - Street 1:149 NE 221ST AVE
Practice Address - Street 2:
Practice Address - City:CROSS CITY
Practice Address - State:FL
Practice Address - Zip Code:32628-5663
Practice Address - Country:US
Practice Address - Phone:352-498-0002
Practice Address - Fax:352-498-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty