Healthcare Provider Details

I. General information

NPI: 1285912949
Provider Name (Legal Business Name): NORTHWEST ARKANSAS HEAD START
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 13TH ST
ROGERS AR
72756-3552
US

IV. Provider business mailing address

210 N 13TH ST
ROGERS AR
72756-3552
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-7317
  • Fax: 479-631-1119
Mailing address:
  • Phone: 479-636-7317
  • Fax: 479-631-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LOU ANN HANEY
Title or Position: CDSW
Credential:
Phone: 479-636-7317