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General NPI Number Information
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NPI Number | 1437895646
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Entity Type | Organization
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Legal Business Name | PROSPERA HEALTHCARE ARKANSAS LLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 4021 W WALNUT ST # 1018
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City | ROGERS
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State | AR
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Zip | 72756-1842
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Country | US
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Telephone | 972-900-2488
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Fax | 972-600-2835
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Provider Business Mailing Address
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Address Line | 4021 W WALNUT ST # 1018
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City | ROGERS
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State | AR
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Zip | 72756-1842
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Country | US
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Telephone | 972-900-2488
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Fax | 972-600-2835
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | PAIGE MCCOMAS
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Credential |
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Telephone | 972-900-2488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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