Provider Demographics
NPI:1770822652
Name:DISABILITY TREATMENT CENTERS OF ARKANSAS
Entity Type:Organization
Organization Name:DISABILITY TREATMENT CENTERS OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:501-219-8043
Mailing Address - Street 1:11524 N RODNEY PARHAM RD
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4187
Mailing Address - Country:US
Mailing Address - Phone:501-219-8043
Mailing Address - Fax:501-219-8045
Practice Address - Street 1:11524 N RODNEY PARHAM RD
Practice Address - Street 2:SUITE 8B
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4187
Practice Address - Country:US
Practice Address - Phone:501-219-8043
Practice Address - Fax:501-219-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-69332080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty