Healthcare Provider Details

I. General information

NPI: 1508037870
Provider Name (Legal Business Name): KIDS FOR THE FUTURE ROGERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3307 N DIXIELAND RD
ROGERS AR
72756-6816
US

IV. Provider business mailing address

PO BOX 130
ROGERS AR
72757-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-5150
  • Fax: 479-986-5191
Mailing address:
  • Phone: 479-986-5150
  • Fax: 479-986-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number25537
License Number StateAR

VIII. Authorized Official

Name: DR. RICHARD W WILDE
Title or Position: CLINIC DIRECTOR
Credential: ED.D.
Phone: 479-986-5150