Organization
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Active
Parent organization
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Other names
Altheimer Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
JEFFERSON COMPREHENSIVE CARE SYSTEM, INC
Authorized official
MR. LARNELL W DAVIS (EXECUTIVE DIRECTOR)
(870) 543-2380
Entity
Organization
Contact information
Practice address
309 S EDLINE, ALTHEIMER, AR 72004-8559
(870) 766-8411
(870) 766-8412
Mailing address
PO BOX 1285, PINE BLUFF, AR 71613-1285
(870) 543-2380
(870) 535-4716
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122651749
—
AR
Enumeration date
06/22/2007
Last updated
07/20/2007
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