Provider Demographics
NPI:1972359396
Name:ABC CHILDREN'S ACADEMY AND DEVELOPMENTAL CENTER INC
Entity type:Organization
Organization Name:ABC CHILDREN'S ACADEMY AND DEVELOPMENTAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-567-5650
Mailing Address - Street 1:820 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5227
Mailing Address - Country:US
Mailing Address - Phone:479-567-5650
Mailing Address - Fax:
Practice Address - Street 1:520 E 3RD ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-5204
Practice Address - Country:US
Practice Address - Phone:479-968-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABC CHILDREN'S ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services