Healthcare Provider Details

I. General information

NPI: 1497220255
Provider Name (Legal Business Name): 8900 JFK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 HIGHWAY 107
SHERWOOD AR
72120
US

IV. Provider business mailing address

8900 HIGHWAY 107
SHERWOOD AR
72120-2932
US

V. Phone/Fax

Practice location:
  • Phone: 501-819-6816
  • Fax: 501-392-6027
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: RACHEL K NORWOOD
Title or Position: VP
Credential:
Phone: 501-224-0846