Provider Demographics
NPI:1679196992
Name:SHARED FAMILIES OF NORTHWEST ARKANSAS L.L.C.
Entity Type:Organization
Organization Name:SHARED FAMILIES OF NORTHWEST ARKANSAS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-274-8271
Mailing Address - Street 1:401 N 8TH ST # 997
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3761
Mailing Address - Country:US
Mailing Address - Phone:479-274-8271
Mailing Address - Fax:479-876-8636
Practice Address - Street 1:805 N 20TH PL STE 1
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3571
Practice Address - Country:US
Practice Address - Phone:479-274-8271
Practice Address - Fax:888-624-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty