Healthcare Provider Details

I. General information

NPI: 1437382322
Provider Name (Legal Business Name): KINGS'S KIDS LEARNING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 CHICOT RD
MABELVALE AR
72103-2200
US

IV. Provider business mailing address

10610 CHICOT RD
MABELVALE AR
72103-2200
US

V. Phone/Fax

Practice location:
  • Phone: 501-565-5437
  • Fax: 501-568-2273
Mailing address:
  • Phone: 501-565-5437
  • Fax: 501-568-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number132752786
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number177708778
License Number StateAR

VIII. Authorized Official

Name: MR. DARRELL BOYD
Title or Position: DIRECTOR
Credential:
Phone: 501-565-5437