Healthcare Provider Details

I. General information

NPI: 1932269123
Provider Name (Legal Business Name): DEQUEEN-MENA EDUCATIONAL COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S HORNBERG AVE
GILLHAM AR
71841
US

IV. Provider business mailing address

PO BOX 110 305 S HORNBERG AVE
GILLHAM AR
71841-0110
US

V. Phone/Fax

Practice location:
  • Phone: 870-386-2251
  • Fax: 870-386-7731
Mailing address:
  • Phone: 870-386-2251
  • Fax: 870-386-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. J. FRANK SCOTT
Title or Position: DIRECTOR
Credential:
Phone: 870-386-2251