Provider Demographics
NPI:1467672162
Name:PERRY COUNTY DAY SERVICE CENTER, INC.
Entity Type:Organization
Organization Name:PERRY COUNTY DAY SERVICE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-889-5755
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72126-0672
Mailing Address - Country:US
Mailing Address - Phone:501-889-5755
Mailing Address - Fax:501-889-5688
Practice Address - Street 1:115 SOUTH PINE STREET
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72126
Practice Address - Country:US
Practice Address - Phone:501-889-5755
Practice Address - Fax:501-889-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities