Provider Demographics
NPI:1629851191
Name:KIDS UNLIMITED LEARNING ACADEMY OF FAYETTEVILLE
Entity Type:Organization
Organization Name:KIDS UNLIMITED LEARNING ACADEMY OF FAYETTEVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:870-336-8100
Mailing Address - Street 1:3127 SOUTHWEST DR STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8404
Mailing Address - Country:US
Mailing Address - Phone:870-336-8100
Mailing Address - Fax:
Practice Address - Street 1:1760 N WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2549
Practice Address - Country:US
Practice Address - Phone:479-443-4420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIRACLE KIDS SUCCESS ACADEMY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation