Provider Demographics
NPI:1295854875
Name:DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:501-661-2859
Mailing Address - Street 1:4815 W MARKHAM ST
Mailing Address - Street 2:SLOT 40
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3866
Mailing Address - Country:US
Mailing Address - Phone:501-661-2859
Mailing Address - Fax:501-661-2691
Practice Address - Street 1:1501 DAWSON ROAD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72236
Practice Address - Country:US
Practice Address - Phone:501-661-2269
Practice Address - Fax:501-661-2855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146398730Medicaid