Provider Demographics
NPI:1629536461
Name:SOUTH ARKANSAS CHILDRENS COALITION
Entity Type:Organization
Organization Name:SOUTH ARKANSAS CHILDRENS COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL EXAMINER
Authorized Official - Prefix:
Authorized Official - First Name:KARRAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CPNP-PC
Authorized Official - Phone:870-562-3392
Mailing Address - Street 1:1154 SOUTHFIELD CUTOFF
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-3451
Mailing Address - Country:US
Mailing Address - Phone:870-562-3392
Mailing Address - Fax:
Practice Address - Street 1:1130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6324
Practice Address - Country:US
Practice Address - Phone:870-862-2272
Practice Address - Fax:870-862-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable