Provider Demographics
NPI:1154888923
Name:FOUNDATION FOR POSITIVELY KIDS
Entity type:Organization
Organization Name:FOUNDATION FOR POSITIVELY KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT MEDICAL CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-455-5639
Mailing Address - Street 1:2480 E TOMPKINS AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7625
Mailing Address - Country:US
Mailing Address - Phone:702-455-5639
Mailing Address - Fax:702-262-0252
Practice Address - Street 1:2480 E TOMPKINS AVE STE 222
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7625
Practice Address - Country:US
Practice Address - Phone:702-455-5639
Practice Address - Fax:702-262-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty