Organization
MIRACLE KIDS SUCCESS ACADEMY, INC.
Active
Organization
MIRACLE KIDS SUCCESS ACADEMY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY TUCKER (VP OF OPERATIONS)
(870) 932-3600
Entity
Organization
Contact information
Practice address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
Mailing address
1900 STILLWATER DR, JONESBORO, AR 72404-9119
(870) 932-3600
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
239436790
—
AR
Enumeration date
05/14/2020
Last updated
11/30/2020
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