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General NPI Number Information
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NPI Number | 1043618309
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Entity Type | Organization
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Legal Business Name | SOUTHWEST COMMUNITY HEALTH CENTER
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 5705 W 65TH ST SUITE C
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3827
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Country | US
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Telephone | 501-779-3528
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Fax | 501-562-4208
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Provider Business Mailing Address
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Address Line | 5705 W 65TH ST SUITE C
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City | LITTLE ROCK
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State | AR
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Zip | 72209-3827
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Country | US
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Telephone | 501-779-3528
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Fax | 501-582-4208
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CHARLESETTA HARVILLE
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Credential |
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Telephone | 501-799-3528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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