Organization
KID CHAMPION HOLDING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN LEE KELLEY (MANAGER / CEO)
(501) 804-9298
Entity
Organization
Contact information
Practice address
11400 N RODNEY PARHAM RD STE C, LITTLE ROCK, AR 72212-4124
(501) 954-0667
Mailing address
11400 N RODNEY PARHAM RD STE C, LITTLE ROCK, AR 72212-4124
(501) 804-9298
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
04/12/2023
Last updated
04/12/2023
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