Healthcare Provider Details

I. General information

NPI: 1891913885
Provider Name (Legal Business Name): THE ARKANSAS CENTER FOR INDEPENDENCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RAY ST
NEWPORT AR
72112-4232
US

IV. Provider business mailing address

200 RAY ST
NEWPORT AR
72112-4232
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-8488
  • Fax: 870-523-3646
Mailing address:
  • Phone: 870-523-8488
  • Fax: 870-523-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: GLENDA MOODY
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 870-523-8488