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General NPI Number Information
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NPI Number | 1598725939
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Entity Type | Organization
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Legal Business Name | MISSION INTERESTS COMMITTEE INC.
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 1111 MAPLEWOOD RD
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City | HARRISON
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State | AR
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Zip | 72601-3005
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Country | US
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Telephone | 870-741-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 MAPLEWOOD RD
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City | HARRISON
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State | AR
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Zip | 72601-3005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PHILLIP LAVERN YODER
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Credential | LNHA
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Telephone | 870-741-5001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 206
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License Number State | AR
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