Organization
KOOLKIDSPIRTION MENTOR SHIP PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY KANE (CEO)
(614) 965-5163
Entity
Organization
Contact information
Practice address
1496 BRICE RD, REYNOLDSBURG, OH 43068-2341
(614) 965-5163
Mailing address
1496 BRICE RD, REYNOLDSBURG, OH 43068-2341
(614) 965-5163
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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