Healthcare Provider Details

I. General information

NPI: 1003973835
Provider Name (Legal Business Name): MONROE COUNTY HUMAN DEVELOPMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 N NEW YORK AVE
BRINKLEY AR
72021-2126
US

IV. Provider business mailing address

1116 N NEW YORK AVE
BRINKLEY AR
72021-2126
US

V. Phone/Fax

Practice location:
  • Phone: 870-734-1155
  • Fax: 870-734-1156
Mailing address:
  • Phone: 870-734-1155
  • Fax: 870-734-1156

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: MARY L HARLIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-734-1155