Provider Demographics
NPI:1194869271
Name:PULASKI COUNTY TRI-DISTRICT EARLY CHILDHOOD PROGRAM
Entity type:Organization
Organization Name:PULASKI COUNTY TRI-DISTRICT EARLY CHILDHOOD PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRSPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-771-8006
Mailing Address - Street 1:2200 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2322
Mailing Address - Country:US
Mailing Address - Phone:501-771-8093
Mailing Address - Fax:501-771-8090
Practice Address - Street 1:2200 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2322
Practice Address - Country:US
Practice Address - Phone:501-771-8093
Practice Address - Fax:501-771-8090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH LITTLE ROCK SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR169882743Medicaid