Healthcare Provider Details

I. General information

NPI: 1922219427
Provider Name (Legal Business Name): ADRIENNE RENEE HOBBS HARRIS MHPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BELAIRE
BENTON AR
72015-3842
US

IV. Provider business mailing address

720 BELAIRE
BENTON AR
72015-3842
US

V. Phone/Fax

Practice location:
  • Phone: 501-326-6160
  • Fax:
Mailing address:
  • Phone: 501-326-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: