Provider Demographics
NPI:1205059383
Name:WHITE COUNTY GROUP HOME
Entity type:Organization
Organization Name:WHITE COUNTY GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY-LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-268-9227
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-0831
Mailing Address - Country:US
Mailing Address - Phone:501-268-9227
Mailing Address - Fax:501-268-7734
Practice Address - Street 1:304 S SOWELL ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6356
Practice Address - Country:US
Practice Address - Phone:501-268-9227
Practice Address - Fax:501-268-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management