Healthcare Provider Details

I. General information

NPI: 1114387701
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RED BUD LN
VIENNA IL
62995-1792
US

IV. Provider business mailing address

PO BOX 759
GOLCONDA IL
62938-0759
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-3079
  • Fax: 618-658-2759
Mailing address:
  • Phone: 618-683-2461
  • Fax: 618-683-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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