Provider Demographics
NPI:1538752225
Name:INDEPENDENT KIDS INC
Entity type:Organization
Organization Name:INDEPENDENT KIDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHTAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALBAFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:954-478-6302
Mailing Address - Street 1:735 CUMBERLAND TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1233
Mailing Address - Country:US
Mailing Address - Phone:954-478-6302
Mailing Address - Fax:305-230-2718
Practice Address - Street 1:1476 N HOMESTEAD BLVD STE 1476
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5008
Practice Address - Country:US
Practice Address - Phone:954-478-6302
Practice Address - Fax:305-230-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center