Provider Demographics
NPI:1700430386
Name:KIDSPIRATION OF MARION COUNTY
Entity Type:Organization
Organization Name:KIDSPIRATION OF MARION COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DT, ECDS
Authorized Official - Phone:870-424-4021
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:YELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72687-0662
Mailing Address - Country:US
Mailing Address - Phone:870-449-7050
Mailing Address - Fax:870-424-4112
Practice Address - Street 1:81 DEVELOPMENT DR
Practice Address - Street 2:
Practice Address - City:YELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72687-0662
Practice Address - Country:US
Practice Address - Phone:870-449-7050
Practice Address - Fax:870-424-4112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDSPIRATION PEDIATRIC THERPAY SERIVC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-31
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care