Provider Demographics
NPI:1194055756
Name:KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA INC
Entity type:Organization
Organization Name:KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VP FOR MARKETING & BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-799-8405
Mailing Address - Street 1:4085 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2574
Mailing Address - Country:US
Mailing Address - Phone:610-799-8343
Mailing Address - Fax:610-799-8318
Practice Address - Street 1:3710 UNIVERSITY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6203
Practice Address - Country:US
Practice Address - Phone:610-799-8343
Practice Address - Fax:610-799-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5146A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health