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MIRACLE KIDS SUCCESS ACADEMY INC. NPI 1639791411


NPI Information

NPI: 1639791411
Provider Name: MIRACLE KIDS SUCCESS ACADEMY, INC.
Classification: Clinic/Center - 261QD1600X
Entity Type: Organization

Specialization: Developmental Disabilities

Address:
1900 STILLWATER DR
JONESBORO, AR
ZIP 72404
Phone: (870) 932-3600
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MIRACLE KIDS SUCCESS ACADEMY, INC. is a developmental disabilities clinic center in Jonesboro, AR. The provider is an entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). MIRACLE KIDS SUCCESS ACADEMY, INC. NPI is 1639791411. 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

The provider's authorized official is Shelly Tucker .
The authorized official title is Vp Of Operations and has the following contact phone number (870) 932-3600.

The enumeration date for this NPI number is 5/14/2020 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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QD1600XClinic/CenterDevelopmental DisabilitiesYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1239436790MEDICAIDARKANSAS

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

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