=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922112390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOMORROWS CHILD LEARNING CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4407 AMARILLO ST
-----------------------------------------------------
City | BLYTHEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72315-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-532-2229
-----------------------------------------------------
Fax | 870-532-8237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4407 AMARILLO ST
-----------------------------------------------------
City | BLYTHEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72315-5702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-532-2229
-----------------------------------------------------
Fax | 870-532-8237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING CLERK
-----------------------------------------------------
Name | MRS. CATHY ELAINE MYRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-532-2229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 5C587
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------