1376671008 NPI number — THE LEARNING CENTER OF NORTHEAST ARKANSAS, INC.

Table of content: (NPI 1376671008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376671008 NPI number — THE LEARNING CENTER OF NORTHEAST ARKANSAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE LEARNING CENTER OF NORTHEAST ARKANSAS, INC.
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:
Provider Other Organization Name Type Code:
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:
1376671008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2808 FOX MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72404-9346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-932-4245
Provider Business Mailing Address Fax Number:
870-931-4457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2808 FOX MEADOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72404-9346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-932-4245
Provider Business Practice Location Address Fax Number:
870-931-4457
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-335-2240

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117641724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117538742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5C636 . This is a "AR BCBS PROVIDER #" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 145862778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132566786 . This is a "DDTCS, 03, 14, 06" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 118326715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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