Healthcare Provider Details

I. General information

NPI: 1417732744
Provider Name (Legal Business Name): EASTER SEALS ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2023
Last Update Date: 08/25/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 I-30 FRONTAGE ROAD
LITTLE ROCK AR
72210
US

IV. Provider business mailing address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-3600
  • Fax:
Mailing address:
  • Phone: 501-227-3600
  • 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: STEPHANIE G SMITH
Title or Position: COO
Credential:
Phone: 501-227-3662