Healthcare Provider Details

I. General information

NPI: 1447518865
Provider Name (Legal Business Name): HENRY WRINKLES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6872 HIGHWAY 34 W
PARAGOULD AR
72450-7644
US

IV. Provider business mailing address

6872 HIGHWAY 34 W
PARAGOULD AR
72450-7644
US

V. Phone/Fax

Practice location:
  • Phone: 870-586-9229
  • Fax:
Mailing address:
  • Phone: 870-586-9229
  • Fax: 870-374-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN BOYD
Title or Position: EXECUTIVE DIRECTOR
Credential: BSE
Phone: 870-586-9229