1003061565 NPI number — CARLENE ANN SANFORD

Table of content: CARLENE ANN SANFORD (NPI 1003061565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003061565 NPI number — CARLENE ANN SANFORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANFORD
Provider First Name:
CARLENE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLEBANK
Provider Other First Name:
CARLENE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003061565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SOUTH MAIN SUITE 500
Provider Second Line Business Mailing Address:
HEALING HANDS THERAPY
Provider Business Mailing Address City Name:
SEARCY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-278-9904
Provider Business Mailing Address Fax Number:
501-278-9906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SOUTH MAIN SUITE 500
Provider Second Line Business Practice Location Address:
HEALING HANDS THERAPY
Provider Business Practice Location Address City Name:
SEARCY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-278-9904
Provider Business Practice Location Address Fax Number:
501-278-9906
Provider Enumeration Date:
11/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 183977721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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