Provider Demographics
NPI:1699114132
Name:KIDS UNLIMITED LEARNING ACADEMY OF CABOT
Entity type:Organization
Organization Name:KIDS UNLIMITED LEARNING ACADEMY OF CABOT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-336-8100
Mailing Address - Street 1:KIDS UNLIMITED LEARNING ACADEMY OF CABOT
Mailing Address - Street 2:3127 SOUTHWEST DRIVE, SUITE A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404
Mailing Address - Country:US
Mailing Address - Phone:870-336-8100
Mailing Address - Fax:
Practice Address - Street 1:KIDS UNLIMITED LEARNING ACADEMY OF CABOT
Practice Address - Street 2:3148 HWY 367 SOUTH
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023
Practice Address - Country:US
Practice Address - Phone:501-841-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28812261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198156724Medicaid