Basic Information
| Provider Information | |||||||||
| NPI: | 1699114132 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS UNLIMITED LEARNING ACADEMY OF CABOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | KIDS UNLIMITED LEARNING ACADEMY OF CABOT | ||||||||
| Address2: | 3127 SOUTHWEST DRIVE, SUITE A | ||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703368100 | ||||||||
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| Practice Location | |||||||||
| Address1: | KIDS UNLIMITED LEARNING ACADEMY OF CABOT | ||||||||
| Address2: | 3148 HWY 367 SOUTH | ||||||||
| City: | CABOT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018413500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | SHELLY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8703368100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | 28812 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 198156724 | 05 | AR | MEDICAID |