Healthcare Provider Details

I. General information

NPI: 1811178841
Provider Name (Legal Business Name): SOUTH ARKANSAS YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 COLUMBIA 11 E
MAGNOLIA AR
71753-9203
US

IV. Provider business mailing address

124 S JACKSON SUITE 308
MAGNOLIA AR
71753-3526
US

V. Phone/Fax

Practice location:
  • Phone: 870-234-6065
  • Fax: 870-234-6175
Mailing address:
  • Phone: 870-234-6550
  • Fax: 870-234-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSALIE PYLE
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 870-234-6550