Organization
CIVITAN CENTER
Active
Other names
CIVITAN SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LEAH L. HENDERSON MSE-ECSE (EXECUTIVE DIRECTOR)
(501) 776-0691
Entity
Organization
Contact information
Practice address
121 SOUTH COX STREET, 121 SOUTH COX STREET, BENTON, AR 72018-0368
(501) 776-0691
(501) 776-0692
Mailing address
121 SOUTH COX STREET, P. O. BOX 368, BENTON, AR 72018-0368
(501) 776-0691
(501) 776-0692
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105505724
—
AR
05
—
116454742
—
AR
05
—
120140715
—
AR
05
—
125972767
—
AR
05
—
131841774
—
AR
01
—
132537786
STATE NONMEDICAID
AR
Enumeration date
01/16/2007
Last updated
03/10/2014
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