1598163628 NPI number — KIDS FOR THE FUTURE OF MARION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598163628 NPI number — KIDS FOR THE FUTURE OF MARION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS FOR THE FUTURE OF MARION, 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:
1598163628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 INGRAM BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72301-3423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-208-8362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 BRIDGES AVE E
Provider Second Line Business Practice Location Address:
BESS GINTY
Provider Business Practice Location Address City Name:
WYNNE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72396-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-208-8362
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GINTY
Authorized Official First Name:
BESS
Authorized Official Middle Name:
HEISLER
Authorized Official Title or Position:
CEO / PRESIDENT
Authorized Official Telephone Number:
870-208-8362

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R880829 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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