Provider Demographics
NPI:1174739437
Name:GRAND PRAIRIE JOB CENTER
Entity type:Organization
Organization Name:GRAND PRAIRIE JOB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-673-8261
Mailing Address - Street 1:427 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-4205
Mailing Address - Country:US
Mailing Address - Phone:870-673-8261
Mailing Address - Fax:870-673-2851
Practice Address - Street 1:427 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-4205
Practice Address - Country:US
Practice Address - Phone:870-673-8261
Practice Address - Fax:870-673-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133306774Medicaid
AR121407724Medicaid
AR121408715Medicaid
AR133304767Medicaid
AR132581786Medicaid