Kicks LLC

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Legal business name

KICKS LLC

Doing business as

Kicks LCC

Practice address

143 S 29TH St
Newark, OH 43055-1903

Phone

(740) 348-0011

NPI assigned

Dec 7, 2020

Last updated

Dec 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diana Spain

Title

Co-Owner

Phone

(740) 348-0011

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• KICKS LCC Doing business as

Locations

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1194321067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 S 29TH ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551903",
            "telephone_number": "740-348-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 S 29TH ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551903",
            "telephone_number": "740-348-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KICKS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "SPAIN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "740-348-0011"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DODD",
            "identifier": "4504343",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KICKS LCC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kenneth L Abram
• Caleb A Kennon, MD
• Susanna Marie Kerr, RN
• Tristan M Kettel, CDCA
• Teresa A. Key-Piciucco, PYSCH ASSISTANT
• Medhanie Kifle Kifle, PA-C
• Christopher Allen Kilgore
• Yoon S Kim, M.D.
• Kindred Nursing Centers East LLC (Newark Healthcare Centre)
• Kindred Nursing Centers East, L.L.C.

• Developmental Disabilities Clinic/Center in Newark, OH
• Providers in Newark, OH by specialty
• Developmental Disabilities Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; 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.