Provider Demographics
NPI:1902136773
Name:ANGEL CARE KIDS THERAPY CENTER INC.
Entity type:Organization
Organization Name:ANGEL CARE KIDS THERAPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:978-521-6150
Mailing Address - Street 1:969 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2011
Mailing Address - Country:US
Mailing Address - Phone:978-521-6150
Mailing Address - Fax:978-521-2659
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2011
Practice Address - Country:US
Practice Address - Phone:978-521-6150
Practice Address - Fax:978-521-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MA8830225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0G0014OtherBCBS
MAAA118890OtherHARVARD PILGRIM
NH13Y005487MA01OtherANTHEM NH