Provider Demographics
NPI:1750596268
Name:COMMUNITY SCHOOL OF CLEBURNE COUNTY
Entity type:Organization
Organization Name:COMMUNITY SCHOOL OF CLEBURNE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-206-0920
Mailing Address - Street 1:74 CLEBURNE PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543
Mailing Address - Country:US
Mailing Address - Phone:501-206-0920
Mailing Address - Fax:501-206-0920
Practice Address - Street 1:74 CLEBURNE PARK ROAD
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543
Practice Address - Country:US
Practice Address - Phone:501-206-0920
Practice Address - Fax:501-206-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113496724Medicaid
AR118418715Medicaid
AR130674774Medicaid
AR161899773Medicaid
AR125463742Medicaid
AR133782767Medicaid
AR132555786OtherVOUCHER VI-B
AR145745778Medicaid