Healthcare Provider Details

I. General information

NPI: 1861615429
Provider Name (Legal Business Name): ASHLEY COUNTY SKILLED WORKCENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N ARKANSAS ST
CROSSETT AR
71635-2836
US

IV. Provider business mailing address

PO BOX 900
CROSSETT AR
71635-0900
US

V. Phone/Fax

Practice location:
  • Phone: 870-364-9253
  • Fax: 870-364-9243
Mailing address:
  • Phone: 870-364-9253
  • Fax: 870-364-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNON RODRIGUEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-364-9253