Provider Demographics
NPI: | 1205040623 |
---|---|
Name: | WORLD SERVICES FOR THE BLIND |
Entity Type: | Organization |
Organization Name: | WORLD SERVICES FOR THE BLIND |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROJECT MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAKISHA |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | DIXON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 501-205-6143 |
Mailing Address - Street 1: | 2811 FAIR PARK BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72204-5044 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-664-7100 |
Mailing Address - Fax: | 501-664-2748 |
Practice Address - Street 1: | 2811 FAIR PARK BLVD |
Practice Address - Street 2: | |
Practice Address - City: | LITTLE ROCK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72204-5044 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-664-7100 |
Practice Address - Fax: | 501-664-2748 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-09 |
Last Update Date: | 2023-05-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
104100000X, 171M00000X, 224Z00000X, 225100000X, 225200000X, 225X00000X, 2355S0801X, 235Z00000X, 251B00000X | ||
AR | 251300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management | ||
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Single Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Single Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Single Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Single Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Single Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Single Specialty | |
No | 251300000X | Agencies | Local Education Agency (LEA) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 1947 | Medicaid |