Healthcare Provider Details

I. General information

NPI: 1528215290
Provider Name (Legal Business Name): ARROWLEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 EAST VINE STREET
VIENNA IL
62995
US

IV. Provider business mailing address

125 NORTH MARKET STREET PO BOX 759
GOLCONDA IL
69238-0759
US

V. Phone/Fax

Practice location:
  • Phone: 618-658-2611
  • Fax: 618-658-2759
Mailing address:
  • Phone: 618-683-2461
  • Fax:

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 State

VIII. Authorized Official

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