Provider Demographics
NPI:1457010340
Name:EASTER SEALS ARKANSAS
Entity Type:Organization
Organization Name:EASTER SEALS ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CPO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-227-3662
Mailing Address - Street 1:3920 WOODLAND HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2495
Mailing Address - Country:US
Mailing Address - Phone:501-227-3600
Mailing Address - Fax:
Practice Address - Street 1:3920 WOODLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2495
Practice Address - Country:US
Practice Address - Phone:501-227-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty