Organization
INDEPENDENT KIDS CO
Active
Organization
INDEPENDENT KIDS CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
XAVIER FORD (CEO)
(702) 918-4687
Entity
Organization
Contact information
Practice address
5625 S RAINBOW BLVD, LAS VEGAS, NV 89118-1854
(702) 845-2265
Mailing address
9828 MAIDENFAIR CT, LAS VEGAS, NV 89148-5530
(702) 919-4686
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
385H00000X
Respite Care
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Enumeration date
05/20/2022
Last updated
05/20/2022
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