Provider Demographics
NPI:1194018325
Name:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:MIDSOUTH HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4939
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:4451 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-7711
Practice Address - Country:US
Practice Address - Phone:870-630-3880
Practice Address - Fax:870-972-4911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184171774Medicaid
AR184171774Medicaid