Provider Demographics
NPI:1538339106
Name:KID KARE INC
Entity type:Organization
Organization Name:KID KARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNGBLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-613-0195
Mailing Address - Street 1:PO BOX 13252
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3252
Mailing Address - Country:US
Mailing Address - Phone:318-613-0195
Mailing Address - Fax:318-449-3737
Practice Address - Street 1:4736 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2505
Practice Address - Country:US
Practice Address - Phone:318-613-0195
Practice Address - Fax:318-449-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty