Basic Information
| Provider Information | |||||||||
| NPI: | 1649814500 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIDS OVERCOMING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 399318 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941399318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665234268 | ||||||||
| FaxNumber: | 5108639848 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 OAKRIDGE DR UNIT 105 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805259651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665234268 | ||||||||
| FaxNumber: | 5108639848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEJAR | ||||||||
| AuthorizedOfficialFirstName: | TORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6234442169 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KIDS OVERCOMING, LLC | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 103K00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.