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General NPI Number Information
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NPI Number | 1972716330
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Entity Type | Organization
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Legal Business Name | NEIGHBOEHOOD COMMUNITY OUTREACH
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 412 BEENE
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City | MAGNOLIA
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State | AR
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Zip | 71753-3414
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Country | US
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Telephone | 870-234-1530
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Fax | 870-234-7508
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Provider Business Mailing Address
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Address Line | PO BOX 2181
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City | MAGNOLIA
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State | AR
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Zip | 71754-7181
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Country | US
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Telephone | 870-234-1530
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Fax | 870-234-7508
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. WANDA R. JACKSON
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Credential |
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Telephone | 870-234-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 145712778
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License Number State | AR
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