Provider Demographics
NPI:1245392752
Name:CONWAY PUBLIC SCHOOLS #01
Entity Type:Organization
Organization Name:CONWAY PUBLIC SCHOOLS #01
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-450-6634
Mailing Address - Street 1:2200 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3750
Mailing Address - Country:US
Mailing Address - Phone:501-450-4800
Mailing Address - Fax:501-450-4898
Practice Address - Street 1:1902 HAIRSTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3227
Practice Address - Country:US
Practice Address - Phone:501-450-6634
Practice Address - Fax:501-450-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WS0200X, 235Z00000X, 251300000X
AR313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116042743Medicaid
AR118688761Medicaid