1972716330 NPI number — NEIGHBOEHOOD COMMUNITY OUTREACH

Table of content: (NPI 1972716330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972716330 NPI number — NEIGHBOEHOOD COMMUNITY OUTREACH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBOEHOOD COMMUNITY OUTREACH
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:
1972716330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2181
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGNOLIA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71754-7181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-234-1530
Provider Business Mailing Address Fax Number:
870-234-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 BEENE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAGNOLIA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71753-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-234-1530
Provider Business Practice Location Address Fax Number:
870-234-7508
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
WANDA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
870-234-1530

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  145712778 , 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: 145712778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132660786 . This is a "EARLY INTERVENTION" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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