Provider Demographics
NPI:1790818334
Name:ASCENT ACQUISITIONS CORP-CYPDC
Entity Type:Organization
Organization Name:ASCENT ACQUISITIONS CORP-CYPDC
Other - Org Name:CHILD & YOUTH PEDIATRIC DAY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-819-0232
Mailing Address - Street 1:3012 TURMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8998
Mailing Address - Country:US
Mailing Address - Phone:870-819-0200
Mailing Address - Fax:870-819-0217
Practice Address - Street 1:1005 BALCOM LN
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472-9502
Practice Address - Country:US
Practice Address - Phone:870-483-1461
Practice Address - Fax:870-483-6520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160747526Medicaid
AR160750724Medicaid
AR5C363OtherBCBS
AR160757742Medicaid