Provider Demographics
NPI:1932165438
Name:HAND REHABILITATION OF W. ARK., INC.
Entity Type:Organization
Organization Name:HAND REHABILITATION OF W. ARK., INC.
Other - Org Name:CENTER FOR PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-632-6337
Mailing Address - Street 1:3918 PECAN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:RUDY
Mailing Address - State:AR
Mailing Address - Zip Code:72952-9026
Mailing Address - Country:US
Mailing Address - Phone:479-632-6337
Mailing Address - Fax:479-632-5916
Practice Address - Street 1:3918 PECAN GROVE RD
Practice Address - Street 2:
Practice Address - City:RUDY
Practice Address - State:AR
Practice Address - Zip Code:72952-9026
Practice Address - Country:US
Practice Address - Phone:479-632-6337
Practice Address - Fax:479-632-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132854742Medicaid
AR138403716Medicaid
AR5B996Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER