Healthcare Provider Details

I. General information

NPI: 1891009221
Provider Name (Legal Business Name): ECONOMIC OPPORTUNITY AGENCY OF WASHINGTON COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 S RAZORBACK RD
FAYETTEVILLE AR
72701-7908
US

IV. Provider business mailing address

614 E EMMA AVE STE M401
SPRINGDALE AR
72764-4634
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-5239
  • Fax:
Mailing address:
  • Phone: 479-872-7479
  • Fax: 479-872-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN RANDALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 479-872-7479