1811140338 NPI number — COUNSELING SERVICES OF EASTERN ARKANSAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811140338 NPI number — COUNSELING SERVICES OF EASTERN ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING SERVICES OF EASTERN ARKANSAS
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:
DELTA CARE COMMUNITY BASED REHABILITATION II
Provider Other Organization Name Type Code:
3
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:
1811140338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2707 BROWNS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-7213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-972-4939
Provider Business Mailing Address Fax Number:
870-972-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 RIGHTOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72342-3223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-338-3363
Provider Business Practice Location Address Fax Number:
870-338-3354
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYERLY
Authorized Official First Name:
DONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER CREDENTIALING
Authorized Official Telephone Number:
870-972-4939

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 178384526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com