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General NPI Number Information
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NPI Number | 1477806925
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Entity Type | Organization
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Legal Business Name | HEALTHY U
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 911 W B ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3501
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Country | US
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Telephone | 479-880-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 911 W B ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-3501
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Country | US
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Telephone | 479-880-2288
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CATHY GEORGE
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Credential | LPEI
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Telephone | 479-880-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0604EI
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License Number State | AR
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