Provider Demographics
NPI:1851103451
Name:KIDDES CROWNED CARE LLC
Entity type:Organization
Organization Name:KIDDES CROWNED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:KIDDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-571-8563
Mailing Address - Street 1:1301 N CENTRAL AVE SUITE 183
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-571-8563
Mailing Address - Fax:
Practice Address - Street 1:44408 W PALO ALISO WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3467
Practice Address - Country:US
Practice Address - Phone:602-571-8563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities