Provider Demographics
NPI:1316794183
Name:STANDUP FOR KIDS
Entity type:Organization
Organization Name:STANDUP FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. OF BUSINESS & PROGRAM OPS.
Authorized Official - Prefix:
Authorized Official - First Name:CARLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDFATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-232-2769
Mailing Address - Street 1:PO BOX 14398
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-4398
Mailing Address - Country:US
Mailing Address - Phone:714-356-5437
Mailing Address - Fax:
Practice Address - Street 1:1055 EL CAMINO DR STE E
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5545
Practice Address - Country:US
Practice Address - Phone:714-356-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No305S00000XManaged Care OrganizationsPoint of Service
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty