Provider Demographics
NPI:1780162792
Name:FORT SMITH CHILDREN'S EMERGENCY SHELTER, INC.
Entity type:Organization
Organization Name:FORT SMITH CHILDREN'S EMERGENCY SHELTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-0018
Mailing Address - Street 1:3015 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6317
Mailing Address - Country:US
Mailing Address - Phone:479-783-0018
Mailing Address - Fax:
Practice Address - Street 1:3015 S 14TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6317
Practice Address - Country:US
Practice Address - Phone:479-783-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health