Provider Demographics
NPI:1447283239
Name:RADAKOVIC KIDS CO INC
Entity type:Organization
Organization Name:RADAKOVIC KIDS CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:248-349-4290
Mailing Address - Street 1:520 W MAIN STREET
Mailing Address - Street 2:PO BOX 206
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-0206
Mailing Address - Country:US
Mailing Address - Phone:248-349-4290
Mailing Address - Fax:248-349-1663
Practice Address - Street 1:520 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-0206
Practice Address - Country:US
Practice Address - Phone:248-349-4290
Practice Address - Fax:248-349-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23-E281313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-E281Medicaid