Healthcare Provider Details

I. General information

NPI: 1144461500
Provider Name (Legal Business Name): CENTRAL ARKANSAS DISABILITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY ST SUITE M
NORTH LITTLE ROCK AR
72114-5552
US

IV. Provider business mailing address

201 W BROADWAY ST SUITE M
NORTH LITTLE ROCK AR
72114-5552
US

V. Phone/Fax

Practice location:
  • Phone: 501-537-1080
  • Fax: 501-537-1082
Mailing address:
  • Phone: 501-537-1080
  • Fax: 501-537-1082

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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELLA MICHELE CROSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-537-1080