Provider Demographics
NPI:1962888727
Name:HELPING KIDS TO RECOVER, INC.
Entity type:Organization
Organization Name:HELPING KIDS TO RECOVER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-217-0616
Mailing Address - Street 1:637 E ALBERTONI ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1539
Mailing Address - Country:US
Mailing Address - Phone:310-217-0616
Mailing Address - Fax:310-217-0545
Practice Address - Street 1:12501 S WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1220
Practice Address - Country:US
Practice Address - Phone:310-217-0616
Practice Address - Fax:310-217-0545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HELPING KIDS TO RECOVER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA197247Medicaid