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General NPI Number Information
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NPI Number | 1134389687
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Entity Type | Organization
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Legal Business Name | DAN AND GAIL FRY INC.
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 1825 E OAK ST SUITE 101
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City | CONWAY
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State | AR
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Zip | 72032-5958
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Country | US
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Telephone | 501-764-1814
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Fax |
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Provider Business Mailing Address
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Address Line | 1825 E OAK ST SUITE 101
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City | CONWAY
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State | AR
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Zip | 72032-5958
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Country | US
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Telephone | 501-764-1814
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Fax |
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Authorized Official
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Title or Position | CLIENT CARE COORDINATOR
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Name | PATRICIA A. CHIOLAK
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Credential | RN
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Telephone | 501-764-1814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 08-074
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License Number State | AR
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