Basic Information
| Provider Information | |||||||||
| NPI: | 1285857417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAYSPRING SERVICES OF ARKANSAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5537 BLEAUX AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727620737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4798725580 | ||||||||
| FaxNumber: | 4798725581 | ||||||||
| Practice Location | |||||||||
| Address1: | 1140 W WALNUT ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727563544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796319996 | ||||||||
| FaxNumber: | 4796311782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | BALDING | ||||||||
| AuthorizedOfficialFirstName: | HELEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4798725580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | AR | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 160429526 | 05 | AR | MEDICAID |