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Organization
SOURCES FOR COMMUNITY INDEPENDENT LIVING SERVICES, INC.
Active
Organization
SOURCES FOR COMMUNITY INDEPENDENT LIVING SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIM MATHER (EXECUTIVE DIRECTOR)
(479) 442-5600
Entity
Organization
Contact information
Practice address
1918 N BIRCH AVE, FAYETTEVILLE, AR 72703-2408
(479) 442-5600
Mailing address
1918 N BIRCH AVE, FAYETTEVILLE, AR 72703-2408
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
CS014
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164857798
—
AR
Enumeration date
02/16/2012
Last updated
02/16/2012
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