MIRACLE KIDS SUCCESS ACADEMY INC. NPI 1568799658

NPI Information

NPI: 1568799658
Provider Name: MIRACLE KIDS SUCCESS ACADEMY, INC.
Classification: Clinic/Center - 261QR0400X
Entity Type: Organization

Specialization: Rehabilitation

Address:
1900 STILLWATER DR
JONESBORO, AR
ZIP 72404
Phone: (870) 932-3600
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MIRACLE KIDS SUCCESS ACADEMY, INC. is a rehabilitation clinic center in Jonesboro, AR. MIRACLE KIDS SUCCESS ACADEMY, INC. NPI is 1568799658. The provider is registered as an organization entity type.

The provider's business location address is:

1900 STILLWATER DR
JONESBORO, AR
ZIP 72404-119
Phone: (870) 932-3600
Fax: (870) 932-3611

The provider's authorized official is Shelly Keller .
The authorized official title is Owner/president and has the following contact phone number (870) 932-3600.

The enumeration date for this NPI number is 11/10/2009 and was last updated on 11/30/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261QD1600X	Clinic/Center	Developmental Disabilities	No
2	261QM0855X	Clinic/Center	Adolescent and Children Mental Health	No
3	261QR0400X	Clinic/Center	Rehabilitation	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	179889724	MEDICAID	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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