Healthcare Provider Details

I. General information

NPI: 1710513338
Provider Name (Legal Business Name): EMERGE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 SE I ST STE 5
BENTONVILLE AR
72712-0078
US

IV. Provider business mailing address

2713 SE I ST STE 5
BENTONVILLE AR
72712-0078
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-4355
  • Fax:
Mailing address:
  • Phone: 479-250-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NAE HEINTZ
Title or Position: PROGRAM SERVICES
Credential: LPC
Phone: 479-250-4355