Provider Demographics
NPI:1801001458
Name:SHELTERED WKSHP OF CRITTENDEN CO INC
Entity Type:Organization
Organization Name:SHELTERED WKSHP OF CRITTENDEN CO INC
Other - Org Name:EASTARK ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:CWA
Authorized Official - Phone:870-732-4159
Mailing Address - Street 1:401 S WOODS ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4355
Mailing Address - Country:US
Mailing Address - Phone:870-732-2750
Mailing Address - Fax:870-735-8171
Practice Address - Street 1:401 S WOODS ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4355
Practice Address - Country:US
Practice Address - Phone:870-732-2750
Practice Address - Fax:870-735-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services