Provider Demographics
NPI:1023236163
Name:STATE OF ARKANSAS
Entity type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DHS DDS SUPERINTENDENT HDC
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-226-6774
Mailing Address - Street 1:1 CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3033
Mailing Address - Country:US
Mailing Address - Phone:870-226-6774
Mailing Address - Fax:870-226-5361
Practice Address - Street 1:1 CENTER CIR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3033
Practice Address - Country:US
Practice Address - Phone:870-226-6774
Practice Address - Fax:870-226-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities