Provider Demographics
NPI:1972944718
Name:KIDS IN NEED OF SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:KIDS IN NEED OF SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:575-956-7209
Mailing Address - Street 1:2311 RANCH CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7807
Mailing Address - Country:US
Mailing Address - Phone:575-388-2414
Mailing Address - Fax:575-388-2457
Practice Address - Street 1:610 N SILVER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6779
Practice Address - Country:US
Practice Address - Phone:575-388-2414
Practice Address - Fax:575-388-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-08245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty