Basic Information
Provider Information
NPI: 1235420654
EntityType: 2
ReplacementNPI:  
OrganizationName: HEALTH RESOURCES OF ARKANSAS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 1355 E MAIN ST
Address2:  
City: BATESVILLE
State: AR
PostalCode: 725013159
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1355 E MAIN ST
Address2:  
City: BATESVILLE
State: AR
PostalCode: 725013159
CountryCode: US
TelephoneNumber: 8707938910
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/20/2011
LastUpdateDate: 04/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SIFFORD
AuthorizedOfficialFirstName: CONNIE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MENTAL HEALTH PARAPROFFESIONAL
AuthorizedOfficialTelephone: 8707938910
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251B00000X  Y AgenciesCase Management 

No ID Information.


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