Healthcare Provider Details

I. General information

NPI: 1326364407
Provider Name (Legal Business Name): CHILD & YOUTH PEDIATRIC DAY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

IV. Provider business mailing address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: AMBER HOGARD
Title or Position: DIRECTOR
Credential:
Phone: 870-933-9528