NPIMap

Organization Active NPI

Kidspeace Services Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Cocoa, FL
National Provider Identifier
1629101423
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
KIDSPEACE SERVICES INC
Practice address
633 B Brevard Avenue
Cocoa, FL 32922
Phone
(321) 631-7740
Fax
(321) 631-7741
NPI assigned
Mar 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael W Slack
Title
VP for Marketing and Business Devel
Phone
(800) 854-3123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

633 B Brevard Avenue
Cocoa, FL 32922

Mailing address

4085 Independence Drive
Schenecksville, PA 18078
Phone (800) 854-3123

National Provider Directory

National Provider Directory
Tax ID family
Kidspeace Services Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

633 Brevard Ave
Ste B
Cocoa, FL 32922
Phone (321) 631-7740

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": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629101423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 INDEPENDENCE DRIVE",
            "city": "SCHENECKSVILLE",
            "state": "PA",
            "postal_code": "18078",
            "telephone_number": "800-854-3123",
            "fax_number": "610-799-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 B BREVARD AVENUE",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "32922",
            "telephone_number": "321-631-7740",
            "fax_number": "321-631-7741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSPEACE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VP FOR MARKETING AND BUSINESS DEVEL",
        "authorized_official_telephone_number": "800-854-3123",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cocoa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.