Healthcare Provider Details

I. General information

NPI: 1811760077
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SHETLERVILLE RD
GOLCONDA IL
62938-4451
US

IV. Provider business mailing address

300 RED BUD LN
VIENNA IL
62995-1792
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-3079
  • Fax:
Mailing address:
  • Phone: 618-652-2046
  • Fax:

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: SENIOR FINANCIAL DIRECTOR
Credential: BS
Phone: 618-652-2046