Provider Demographics
NPI:1386977908
Name:ALL AMERICAN FUN FACTORY (AAFF)
Entity type:Organization
Organization Name:ALL AMERICAN FUN FACTORY (AAFF)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIESHA
Authorized Official - Middle Name:MAZIN
Authorized Official - Last Name:EASTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:469-865-9209
Mailing Address - Street 1:530 RISING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3860
Mailing Address - Country:US
Mailing Address - Phone:469-865-9209
Mailing Address - Fax:
Practice Address - Street 1:530 RISING RIDGE DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3860
Practice Address - Country:US
Practice Address - Phone:469-865-9209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities