Organization
CHILD & YOUTH PEDIATRIC DAY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER HOGARD (DIRECTOR)
(870) 933-9528
Entity
Organization
Contact information
Practice address
806 GLENDALE ST, JONESBORO, AR 72401-4455
(870) 933-9528
Mailing address
806 GLENDALE ST, JONESBORO, AR 72401-4455
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160740526
—
AR
05
—
160751724
—
AR
05
—
160767742
—
AR
Enumeration date
04/14/2010
Last updated
04/14/2010
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