Provider Demographics
NPI:1376601773
Name:GILEAD FAMILY RESOURCE CENTER INC
Entity Type:Organization
Organization Name:GILEAD FAMILY RESOURCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-222-4500
Mailing Address - Street 1:515 HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:MCGEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654
Mailing Address - Country:US
Mailing Address - Phone:870-222-4500
Mailing Address - Fax:870-222-4505
Practice Address - Street 1:515 HOLLY STREET
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654
Practice Address - Country:US
Practice Address - Phone:870-222-4500
Practice Address - Fax:870-222-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management