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General NPI Number Information
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NPI Number | 1538478250
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Entity Type | Organization
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Legal Business Name | SOUTH ARKANSAS YOUTH SERVICES, INC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 300 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-863-5153
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Fax | 870-863-5154
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Provider Business Mailing Address
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Address Line | 300 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730-4569
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Country | US
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Telephone | 870-863-5153
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Fax | 870-863-5154
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Authorized Official
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Title or Position | MHPP
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Name | MS. LATRINA LASHEY JACKSON
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Credential |
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Telephone | 870-863-5153
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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 |
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License Number State | AR
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