Healthcare Provider Details

I. General information

NPI: 1043530017
Provider Name (Legal Business Name): KIDS FOR THE FUTURE OF FORREST CITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 HIGHWAY 1 N
FORREST CITY AR
72335-7637
US

IV. Provider business mailing address

3998 HIGHWAY 1 N PO BOX 2192
FORREST CITY AR
72335-7637
US

V. Phone/Fax

Practice location:
  • Phone: 870-633-1737
  • Fax: 870-633-1738
Mailing address:
  • Phone: 870-633-1737
  • Fax: 870-633-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number26859
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number26859
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26859
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number26859
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26859
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number26859
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number26859
License Number StateAR
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number26859
License Number StateAR
# 9
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number26859
License Number StateAR

VIII. Authorized Official

Name: DR. THOMAS R HEISLER
Title or Position: CEO
Credential: PHD
Phone: 870-633-1737