Provider Demographics
NPI:1326284266
Name:LIFE STRATEGIES OF ARKANSAS
Entity Type:Organization
Organization Name:LIFE STRATEGIES OF ARKANSAS
Other - Org Name:MARIANNA OUTPATIENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:POUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-735-0300
Mailing Address - Street 1:63 N CAROLINA ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2002
Mailing Address - Country:US
Mailing Address - Phone:870-295-3300
Mailing Address - Fax:870-295-6135
Practice Address - Street 1:703 CALVIN AVERY DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-6501
Practice Address - Country:US
Practice Address - Phone:870-732-1817
Practice Address - Fax:870-702-7111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE STRATEGIES OF ARKANSAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-24
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171504526261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171504526Medicaid