Healthcare Provider Details

I. General information

NPI: 1043618309
Provider Name (Legal Business Name): SOUTHWEST COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 W 65TH ST SUITE C
LITTLE ROCK AR
72209-3827
US

IV. Provider business mailing address

5705 W 65TH ST SUITE C
LITTLE ROCK AR
72209-3827
US

V. Phone/Fax

Practice location:
  • Phone: 501-779-3528
  • Fax: 501-562-4208
Mailing address:
  • Phone: 501-779-3528
  • Fax: 501-582-4208

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. CHARLESETTA HARVILLE
Title or Position: DIRECTOR
Credential:
Phone: 501-799-3528