1669451928 NPI number — SOUTHWEST ARKANSAS DEVELOPMENT COUNCIL, INC.

Table of content: (NPI 1669451928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669451928 NPI number — SOUTHWEST ARKANSAS DEVELOPMENT COUNCIL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST ARKANSAS DEVELOPMENT COUNCIL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SWADC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669451928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3902 SANDERSON LN
Provider Second Line Business Mailing Address:
N/A
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71854-2516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3902 SANDERSON LN
Provider Second Line Business Practice Location Address:
N/A
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71854-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-773-0819
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKARD
Authorized Official First Name:
TOM
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-773-5504

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  AR3619 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 14284 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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