Provider Demographics
NPI:1669690830
Name:CARROLL COUNTY LEARNING CENTER
Entity type:Organization
Organization Name:CARROLL COUNTY LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-423-6648
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-0107
Mailing Address - Country:US
Mailing Address - Phone:870-423-3000
Mailing Address - Fax:870-423-6646
Practice Address - Street 1:705 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-3105
Practice Address - Country:US
Practice Address - Phone:870-423-3000
Practice Address - Fax:870-423-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0021891251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101390724Medicaid
AR132293774Medicaid
AR125879767Medicaid
AR118564715Medicaid
AR132665786Medicaid