Provider Demographics
NPI:1528384013
Name:KID QUEST INCORPORATED
Entity Type:Organization
Organization Name:KID QUEST INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERTHENA
Authorized Official - Middle Name:BO
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-772-3314
Mailing Address - Street 1:425 PARKDALE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-4317
Mailing Address - Country:US
Mailing Address - Phone:501-772-3314
Mailing Address - Fax:501-374-4187
Practice Address - Street 1:425 PARKDALE ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-4317
Practice Address - Country:US
Practice Address - Phone:501-772-3314
Practice Address - Fax:501-374-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR145713778251B00000X, 251C00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145713778Medicaid