Provider Demographics
NPI:1720414451
Name:BEAN TOTS AND TODDLERS
Entity Type:Organization
Organization Name:BEAN TOTS AND TODDLERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-933-1989
Mailing Address - Street 1:1220 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4519
Mailing Address - Country:US
Mailing Address - Phone:870-933-1989
Mailing Address - Fax:870-268-6705
Practice Address - Street 1:1220 STONE ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4519
Practice Address - Country:US
Practice Address - Phone:870-933-1989
Practice Address - Fax:870-268-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0000Medicaid