Basic Information
| Provider Information | |||||||||
| NPI: | 1073916656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS FOR THE FUTURE OF MARIANNA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARIANNA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723602102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702955280 | ||||||||
| FaxNumber: | 8702955390 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MARIANNA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723602102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702955280 | ||||||||
| FaxNumber: | 8702955390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2014 | ||||||||
| LastUpdateDate: | 09/26/2014 | ||||||||
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| AuthorizedOfficialLastName: | GINTY | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8702088362 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R073321 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.