Healthcare Provider Details

I. General information

NPI: 1811797673
Provider Name (Legal Business Name): PILOTAGE HEALING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4979 OLD GREENWOOD RD STE B2
FORT SMITH AR
72903-6906
US

IV. Provider business mailing address

775 LAUREL DR
GREENWOOD AR
72936-5714
US

V. Phone/Fax

Practice location:
  • Phone: 479-289-5220
  • Fax:
Mailing address:
  • Phone: 479-445-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VAUGHN DECOSTER
Title or Position: DIRECTOR
Credential: PHD
Phone: 479-445-9814