Basic Information
| Provider Information | |||||||||
| NPI: | 1588913636 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASCENT CHILDREN'S HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 GLENDALE ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709339528 | ||||||||
| FaxNumber: | 8709339778 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 GLENDALE ST | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724014455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709339528 | ||||||||
| FaxNumber: | 8709339778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOGARD | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINIC DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8709339528 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.