1437382322 NPI number — KINGS'S KIDS LEARNING CENTER, LLC

Table of content: (NPI 1437382322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437382322 NPI number — KINGS'S KIDS LEARNING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINGS'S KIDS LEARNING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KING'S KIDS LEARNING CENTER, LLC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437382322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10610 CHICOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MABELVALE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72103-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-565-5437
Provider Business Mailing Address Fax Number:
501-568-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10610 CHICOT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MABELVALE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72103-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-565-5437
Provider Business Practice Location Address Fax Number:
501-568-2273
Provider Enumeration Date:
08/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BOYD
Authorized Official First Name:
DARRELL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
501-565-5437

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  177708778 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302R00000X , with the licence number: 132752786 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132752786 . This is a "NON-MEDICAID #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 177708778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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