NPIMap

Organization Active NPI

Mentally Ill Kids in Distress

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pueblo, CO
National Provider Identifier
1336800341
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MENTALLY ILL KIDS IN DISTRESS
Practice address
115 E Riverwalk Unit 110
Pueblo, CO 81003-3308
Phone
(602) 252-1240
Fax
(602) 840-3409
NPI assigned
Jan 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Jeff Kazmierczak, RN,MSN,MBA
Title
Ceo
Phone
(602) 253-1240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

115 E Riverwalk Unit 110
Pueblo, CO 81003-3308

Mailing address

7816 N 19TH Ave
Phoenix, AZ 85021-7036
Phone (602) 253-1240

Other names 1

  • MIKID Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mentally Ill Kids in Distress12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

115 E Riverwalk
Unit 110
Pueblo, CO 81003
Phone (602) 252-1240

NPI Registry JSON

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

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1336800341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7816 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850217036",
            "telephone_number": "602-253-1240",
            "fax_number": "602-840-3409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E RIVERWALK UNIT 110",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033308",
            "telephone_number": "602-252-1240",
            "fax_number": "602-840-3409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENTALLY ILL KIDS IN DISTRESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "KAZMIERCZAK",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-253-1240",
        "authorized_official_credential": "RN,MSN,MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIKID",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MIKID",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.