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NPI Code Detail

MEDICARE: CONWAY COUNTY COMMUNITY SERVICE INC

MEDICARE: CONWAY COUNTY COMMUNITY SERVICE INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1962637082
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONWAY COUNTY COMMUNITY SERVICE INC
Provider Business Mailing Address
First Line : P.O. BOX 1133
Second Line :
City : CLINTON
State : AR
Zip : 72031
Country : US
Telephone Number : 501-745-2956
Fax Number : 501-745-2956
Provider Business Practice Location Address
First Line : 119 SHAKE RAG RD
Second Line :
City : CLINTON
State : AR
Zip : 72031-6682
Country : US
Telephone Number : 501-745-2956
Fax Number : 501-745-6918
Authorized Official
Title or Position : PA/CREDENTIALING CLERK
Name : ANGELA LYNN WHEAT
Credential :
Telephone Number : 501-354-4589
Provider Enumeration Date : 05/19/2009
Last Update Date : 03/03/2021

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Directions to “CONWAY COUNTY COMMUNITY SERVICE INC ” Practice Location

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