Healthcare Provider Details

I. General information

NPI: 1417082140
Provider Name (Legal Business Name): ARKANSAS EASTER SEAL SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
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: 501-227-3662
  • Fax: 501-227-3658
Mailing address:
  • Phone: 501-227-3662
  • Fax: 501-227-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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