Basic Information
| Provider Information | |||||||||
| NPI: | 1255507273 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS FOR THE FUTURE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2192 | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723362192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706331737 | ||||||||
| FaxNumber: | 8706331738 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 DAWSON RD | ||||||||
| Address2: | |||||||||
| City: | FORREST CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723352088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706302328 | ||||||||
| FaxNumber: | 8706626826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | GINTY | ||||||||
| AuthorizedOfficialFirstName: | BESS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8706331737 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 103TC2200X | 26859 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | 165702526 | 05 | AR | MEDICAID |