Healthcare Provider Details

I. General information

NPI: 1992080469
Provider Name (Legal Business Name): C&D DISABILITY.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4806 W 9TH STREET
PINE BLUFF AR
71603
US

IV. Provider business mailing address

4806 W 9TH AVE
PINE BLUFF AR
71603-1683
US

V. Phone/Fax

Practice location:
  • Phone: 870-879-6149
  • Fax: 870-879-1998
Mailing address:
  • Phone: 870-879-6149
  • Fax: 870-879-1998

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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA JEAN-LACY ROBERSON
Title or Position: CEO/
Credential:
Phone: 870-879-6149