Provider Demographics
NPI:1013008838
Name:ALL GOD'S CHILDREN THERAPY CENTER
Entity Type:Organization
Organization Name:ALL GOD'S CHILDREN THERAPY CENTER
Other - Org Name:ARKANSAS CHILDREN'S THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:501-241-0410
Mailing Address - Street 1:2701 T P WHITE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-2514
Mailing Address - Country:US
Mailing Address - Phone:501-241-0410
Mailing Address - Fax:501-241-0125
Practice Address - Street 1:500 WEST HICKORY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3570
Practice Address - Country:US
Practice Address - Phone:501-241-0410
Practice Address - Fax:501-241-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 22382251P0200X
AROTR1657225XP0200X
ARSP#2013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157756742Medicaid