Provider Demographics
NPI:1447499942
Name:KIMBERCO FUTURE LEADERS INC
Entity type:Organization
Organization Name:KIMBERCO FUTURE LEADERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:602-774-1774
Mailing Address - Street 1:6412 W FAWN DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2773
Mailing Address - Country:US
Mailing Address - Phone:602-774-1774
Mailing Address - Fax:
Practice Address - Street 1:1021 S 7TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3725
Practice Address - Country:US
Practice Address - Phone:800-587-0332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBERCO FUTURE LEADERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency