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General NPI Number Information
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NPI Number | 1346365707
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Entity Type | Organization
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Legal Business Name | MISS POLLY'S DAY CARE CENTER
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 613 CHURCH ST N
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City | WYNNE
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State | AR
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Zip | 72396-2603
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Country | US
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Telephone | 870-238-2368
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Fax | 870-238-7889
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Provider Business Mailing Address
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Address Line | 613 CHURCH ST N
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City | WYNNE
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State | AR
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Zip | 72396-2603
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Country | US
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Telephone | 870-238-2368
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Fax | 870-238-7889
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. CONNIE LEA HOWELL
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Credential | M.S.E
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Telephone | 870-238-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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