| Kid Champion Holding Llc | |
|
11400 N Rodney Parham Rd Ste C Little Rock AR 72212-4124 | |
| (501) 954-0667 | |
| Not Available |
| Full Name | Kid Champion Holding Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11400 N Rodney Parham Rd Ste C, Little Rock, Arkansas |
| Authorized Official Name and Position | Kevin Lee Kelley (MANAGER / CEO) |
| Authorized Official Contact | 5018049298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kid Champion Holding Llc 11400 N Rodney Parham Rd Ste C Little Rock AR 72212-4124 Ph: (501) 804-9298 | Kid Champion Holding Llc 11400 N Rodney Parham Rd Ste C Little Rock AR 72212-4124 Ph: (501) 954-0667 |
| NPI Number | 1487340535 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487340535 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 302R00000X | Health Maintenance Organization | (* (Not Available)) | Secondary |
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