Provider Demographics
NPI:1669451928
Name:SOUTHWEST ARKANSAS DEVELOPMENT COUNCIL, INC.
Entity Type:Organization
Organization Name:SOUTHWEST ARKANSAS DEVELOPMENT COUNCIL, INC.
Other - Org Name:SWADC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOCKARD
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:870-773-5504
Mailing Address - Street 1:3902 SANDERSON LN
Mailing Address - Street 2:N/A
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3902 SANDERSON LN
Practice Address - Street 2:N/A
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2516
Practice Address - Country:US
Practice Address - Phone:870-773-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3619251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR14284Medicaid