Healthcare Provider Details

I. General information

NPI: 1851756597
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLIVER ST
VIENNA IL
62995-1686
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: 618-658-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

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