NPIMap

Organization Active NPI

Kiddieklubhouse,LLC

  • Child Mental Illness Respite Care
  • Muncie, IN
National Provider Identifier
1083363915
Registry record updated Mar 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
Legal business name
KIDDIEKLUBHOUSE,LLC
Doing business as
KiddieKlubHouse, LLC
Practice address
2209 W Surrey Dr
Muncie, IN 47304-1448
Phone
(765) 283-8895
NPI assigned
Mar 18, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Amy CarmanNPI 1336640572
Title
Manager
Phone
(765) 283-8895

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child Mental Illness Respite Care 385HR2055X Primary

Addresses

Primary practice location

2209 W Surrey Dr
Muncie, IN 47304-1448

Mailing address

2209 W Surrey Dr
Muncie, IN 47304-1448
Phone (765) 283-8895

Other names 1

  • KiddieKlubHouse, LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647561600000",
    "number": "1083363915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 W SURREY DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473041448",
            "telephone_number": "765-283-8895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 W SURREY DR",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473041448",
            "telephone_number": "765-283-8895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDDIEKLUBHOUSE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-18",
        "last_updated": "2022-03-18",
        "certification_date": "2022-03-18",
        "status": "A",
        "authorized_official_last_name": "CARMAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "765-283-8895",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KiddieKlubHouse, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muncie, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.