Healthcare Provider Details

I. General information

NPI: 1508079831
Provider Name (Legal Business Name): PHILLIPS COUNTY DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 W HIGHWAY 49
WEST HELENA AR
72390-1716
US

IV. Provider business mailing address

1221 W HIGHWAY 49
WEST HELENA AR
72390-1716
US

V. Phone/Fax

Practice location:
  • Phone: 870-572-3417
  • Fax: 870-572-2653
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: HENRIETTA WILSON
Title or Position: DIRECTOR
Credential:
Phone: 870-572-3417