Provider Demographics
NPI:1700033479
Name:ARROWLEAF
Entity Type:Organization
Organization Name:ARROWLEAF
Other - Org Name:HARDIN CO. OFFICE LOCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-652-2046
Mailing Address - Street 1:125 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938-1136
Mailing Address - Country:US
Mailing Address - Phone:618-287-7010
Mailing Address - Fax:618-287-7016
Practice Address - Street 1:147 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:IL
Practice Address - Zip Code:62931
Practice Address - Country:US
Practice Address - Phone:618-285-1020
Practice Address - Fax:618-285-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========003Medicaid