Provider Demographics
NPI:1760531651
Name:MARVA WORKSHOP
Entity Type:Organization
Organization Name:MARVA WORKSHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-968-4420
Mailing Address - Street 1:1205 S ARKANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6736
Mailing Address - Country:US
Mailing Address - Phone:479-968-4420
Mailing Address - Fax:479-968-5430
Practice Address - Street 1:1205 S ARKANSAS AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6736
Practice Address - Country:US
Practice Address - Phone:479-968-4420
Practice Address - Fax:479-968-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2380OtherSTATE DDS PROVIDER CODE