Healthcare Provider Details

I. General information

NPI: 1306589973
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W VIENNA ST
ANNA IL
62906-1024
US

IV. Provider business mailing address

300 RED BUD LN
VIENNA IL
62995-1792
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-8415
  • Fax: 618-833-6545
Mailing address:
  • Phone: 618-658-3079
  • Fax: 618-658-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAURA K COWSER
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 618-652-2046