Healthcare Provider Details

I. General information

NPI: 1508511593
Provider Name (Legal Business Name): FRIENDSHIP COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S LINCOLN ST
LOWELL AR
72745-9782
US

IV. Provider business mailing address

1913 W EMMA AVE
SPRINGDALE AR
72762-3914
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-0744
  • Fax:
Mailing address:
  • Phone: 479-228-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TORI PATTERMANN
Title or Position: BCBA
Credential:
Phone: 479-957-4967