Healthcare Provider Details

I. General information

NPI: 1275912263
Provider Name (Legal Business Name): COMMUNITY SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S OSWEGO AVE
RUSSELLVILLE AR
72802-2673
US

IV. Provider business mailing address

PO BOX 679
MORRILTON AR
72110-0679
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-3370
  • Fax: 479-967-2775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. LINDA FOSHEE
Title or Position: BILLING CLERK
Credential:
Phone: 501-354-4589