NPIMap

Organization Active NPI

Miracle Kids Success Academy North

  • Rehabilitation Clinic/Center
  • Jonesboro, AR
National Provider Identifier
1912479452
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
MIRACLE KIDS SUCCESS ACADEMY NORTH
Practice address
806 Glendale St
Jonesboro, AR 72401-4455
Phone
(870) 333-2600
NPI assigned
Dec 21, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shelly Keller
Title
Ceo/Owner
Phone
(870) 761-6680

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

806 Glendale St
Jonesboro, AR 72401-4455

Mailing address

1900 Stillwater Dr
Jonesboro, AR 72404-9119
Phone (870) 333-2600

National Provider Directory

National Provider Directory
Tax ID family
Miracle Kids Success Academy North4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1912479452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 STILLWATER DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049119",
            "telephone_number": "870-333-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 GLENDALE ST",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014455",
            "telephone_number": "870-333-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIRACLE KIDS SUCCESS ACADEMY NORTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-21",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "870-761-6680"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.