Healthcare Provider Details

I. General information

NPI: 1508095290
Provider Name (Legal Business Name): EASTER SEALS ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD
LITTLE ROCK AR
72212-2495
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: 501-227-3606
Mailing address:
  • Phone: 501-227-3600
  • Fax: 501-227-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SMITH
Title or Position: VICE PRESIDENT ADMIN & FINANCE
Credential:
Phone: 501-227-3662