Provider Demographics
NPI:1447031562
Name:MAGIG KINGDOM KIDS SERVICES LLC
Entity type:Organization
Organization Name:MAGIG KINGDOM KIDS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WUILMAY
Authorized Official - Middle Name:DEURITH
Authorized Official - Last Name:VARELA MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-592-6596
Mailing Address - Street 1:6827 PARTRIDGE LN STE E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-5312
Mailing Address - Country:US
Mailing Address - Phone:954-592-6596
Mailing Address - Fax:
Practice Address - Street 1:6827 PARTRIDGE LN STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-5312
Practice Address - Country:US
Practice Address - Phone:954-592-6596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health