Healthcare Provider Details

I. General information

NPI: 1922130368
Provider Name (Legal Business Name): SUPERINTENDENT OF DELIGHT HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 E. CHERRY ST.
DELIGHT AR
71940
US

IV. Provider business mailing address

PO BOX 8
DELIGHT AR
71940-0008
US

V. Phone/Fax

Practice location:
  • Phone: 870-379-2214
  • Fax: 870-379-2448
Mailing address:
  • Phone: 870-379-2214
  • Fax: 870-379-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAVON FLAHERTY
Title or Position: SUPERINTENDENT
Credential:
Phone: 870-379-2214