Provider Demographics
NPI:1588400949
Name:KJ'S AFTER-SCHOOL PROGRAM
Entity type:Organization
Organization Name:KJ'S AFTER-SCHOOL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:919-559-4999
Mailing Address - Street 1:7052 PAINT ROCK LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6912
Mailing Address - Country:US
Mailing Address - Phone:919-559-4999
Mailing Address - Fax:
Practice Address - Street 1:7052 PAINT ROCK LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6912
Practice Address - Country:US
Practice Address - Phone:919-559-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health