Healthcare Provider Details

I. General information

NPI: 1871990358
Provider Name (Legal Business Name): ARKANSAS QUALITY THERAPY CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14105 SKYLINE DR
ALEXANDER AR
72002-1824
US

IV. Provider business mailing address

14105 SKYLINE DR
ALEXANDER AR
72002-1824
US

V. Phone/Fax

Practice location:
  • Phone: 501-765-2911
  • Fax:
Mailing address:
  • Phone: 501-765-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateAR

VIII. Authorized Official

Name: TROOPER TOLBERT
Title or Position: DIRECTOR
Credential:
Phone: 501-765-2911