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General NPI Number Information
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NPI Number | 1467862821
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PROGRAM
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 3529 E NETTLETON AVE STE I
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City | JONESBORO
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State | AR
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Zip | 72401-5590
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Country | US
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Telephone | 870-336-3360
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Fax | 870-336-3878
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Provider Business Mailing Address
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Address Line | 3529 E NETTLETON AVE STE I
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City | JONESBORO
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State | AR
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Zip | 72401-5500
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Country | US
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Telephone | 870-336-3360
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Fax | 870-336-3878
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRELL JENKINS
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Credential | B.A. , A.D.C.; AACJ
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Telephone | 870-919-0285
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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 | 1532
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License Number State | AR
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