1962407759 NPI number — OUACHITA ENRICHMENT CENTERS, INC.

Table of content: (NPI 1962407759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962407759 NPI number — OUACHITA ENRICHMENT CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUACHITA ENRICHMENT CENTERS, 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:
Provider Other Organization Name Type Code:
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:
1962407759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 W WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDEN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71701-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-836-3056
Provider Business Mailing Address Fax Number:
870-498-8838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71701-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-836-3056
Provider Business Practice Location Address Fax Number:
870-498-8838
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDLER
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
870-836-3056

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , 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: 119038724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132571786 . This is a "NON-MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 140993742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126430767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134491774 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118433715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146082778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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