Provider Demographics
NPI:1891913885
Name:THE ARKANSAS CENTER FOR INDEPENDENCE, INC.
Entity Type:Organization
Organization Name:THE ARKANSAS CENTER FOR INDEPENDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-523-8488
Mailing Address - Street 1:8149 CURTNER
Mailing Address - Street 2:P.O. BOX 785
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-0785
Mailing Address - Country:US
Mailing Address - Phone:870-523-8488
Mailing Address - Fax:870-523-3646
Practice Address - Street 1:8149 CURTNER
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-0785
Practice Address - Country:US
Practice Address - Phone:870-523-8488
Practice Address - Fax:870-523-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102857724Medicaid
AR114792715Medicaid
AR131737767Medicaid