Provider Demographics
NPI:1518403252
Name:STI WORK CARE
Entity type:Organization
Organization Name:STI WORK CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SLADER
Authorized Official - Last Name:AGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-249-9944
Mailing Address - Street 1:3511 SE J ST
Mailing Address - Street 2:STE 9 PMB 239
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3856
Mailing Address - Country:US
Mailing Address - Phone:479-249-9944
Mailing Address - Fax:479-249-9894
Practice Address - Street 1:1504 SE 28TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3988
Practice Address - Country:US
Practice Address - Phone:479-249-9944
Practice Address - Fax:479-249-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR172M00000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty