Provider Demographics
NPI:1952047680
Name:ARROWLEAF
Entity Type:Organization
Organization Name:ARROWLEAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-652-2046
Mailing Address - Street 1:300 RED BUD LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:IL
Mailing Address - Zip Code:62995-1792
Mailing Address - Country:US
Mailing Address - Phone:618-658-3079
Mailing Address - Fax:618-658-2759
Practice Address - Street 1:204 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1549
Practice Address - Country:US
Practice Address - Phone:618-833-8551
Practice Address - Fax:618-833-2911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARROWLEAF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)