Provider Demographics
NPI:1417087131
Name:ABC CHILDREN'S ACADEMY
Entity Type:Organization
Organization Name:ABC CHILDREN'S ACADEMY
Other - Org Name:RECOVERY ZONE PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:479-477-0385
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-5048
Mailing Address - Fax:479-968-1498
Practice Address - Street 1:500 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5204
Practice Address - Country:US
Practice Address - Phone:479-968-5048
Practice Address - Fax:479-968-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR222Q00000X
225100000X, 225X00000X, 235Z00000X, 251B00000X, 251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176325778Medicaid
AR197933724Medicaid
AR197932724Medicaid
AR5F626OtherBCBS