Provider Demographics
NPI:1962804468
Name:FOUNDATION FOR POSITIVELY KIDS, A NONPROFIT CORPORATION
Entity type:Organization
Organization Name:FOUNDATION FOR POSITIVELY KIDS, A NONPROFIT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-262-0037
Mailing Address - Street 1:4375 LAS VEGAS BLVD N STE 10
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0587
Mailing Address - Country:US
Mailing Address - Phone:702-620-0372
Mailing Address - Fax:702-272-2421
Practice Address - Street 1:701 N PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2400
Practice Address - Country:US
Practice Address - Phone:702-262-0037
Practice Address - Fax:702-476-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19991199570311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100538800Medicaid