Provider Demographics
NPI:1538583414
Name:KIDS ELITE YOUTH ORGANIZATION
Entity type:Organization
Organization Name:KIDS ELITE YOUTH ORGANIZATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-877-1454
Mailing Address - Street 1:6088 REYNOLDS CIR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-1256
Mailing Address - Country:US
Mailing Address - Phone:706-877-1454
Mailing Address - Fax:
Practice Address - Street 1:6088 REYNOLDS CIR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-1256
Practice Address - Country:US
Practice Address - Phone:706-877-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS ELITE YOUTH ORGANIZATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable