Basic Information
| Provider Information | |||||||||
| NPI: | 1225523483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ABLE KIDS CO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 HEATHCOT PL | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957625928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086237713 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5170 GOLDEN FOOTHILL PKWY | ||||||||
| Address2: | |||||||||
| City: | EL DORADO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957629608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166936469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | BINGAMAN | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9166936469 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1285018002 | 01 | ASHLEIGH GUICH | OTHER | 1568715704 | 01 | CHERYL TURBOO | OTHER | 1710337258 | 01 | CA | JUST FOR J | OTHER |