Healthcare Provider Details

I. General information

NPI: 1568890796
Provider Name (Legal Business Name): ASCENT CHILDREN'S HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 PINE ST
ARKADELPHIA AR
71923-4335
US

IV. Provider business mailing address

2410 PINE ST
ARKADELPHIA AR
71923-4335
US

V. Phone/Fax

Practice location:
  • Phone: 870-245-2210
  • Fax: 870-245-2225
Mailing address:
  • Phone: 870-245-2210
  • Fax: 870-245-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: ATHENA HOLMES
Title or Position: ECDS
Credential:
Phone: 870-245-2210