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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