Healthcare Provider Details

I. General information

NPI: 1467672162
Provider Name (Legal Business Name): PERRY COUNTY DAY SERVICE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SOUTH PINE STREET
PERRYVILLE AR
72126
US

IV. Provider business mailing address

PO BOX 672
PERRYVILLE AR
72126-0672
US

V. Phone/Fax

Practice location:
  • Phone: 501-889-5755
  • Fax: 501-889-5688
Mailing address:
  • Phone: 501-889-5755
  • Fax: 501-889-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateAR

VIII. Authorized Official

Name: MS. CHRISTY CAMPBELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-889-5755