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General NPI Number Information
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NPI Number | 1326857301
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Entity Type | Organization
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Legal Business Name | FAMILY TIES ENTERTAINMENT
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 11 JOHNNY LN
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City | SHERWOOD
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State | AR
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Zip | 72120
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Country | US
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Telephone | 605-354-4772
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Fax |
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Provider Business Mailing Address
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Address Line | 11 JOHNNY LN
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City | SHERWOOD
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State | AR
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Zip | 72120-9303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ ADULT PROGRAM FACILITATOR
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Name | MR. KNOA SMITH
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Credential |
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Telephone | 605-354-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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