Organization
PROVIDENCE PCC OF SEARCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA JACKSON (ADMINISTRATOR)
(501) 268-4169
Entity
Organization
Contact information
Practice address
3014 E MOORE AVE, SEARCY, AR 72143-5069
(501) 268-4169
Mailing address
3014 E MOORE AVE, SEARCY, AR 72143-5069
(501) 268-4169
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
076
AR
Other
Enumeration date
04/05/2013
Last updated
04/05/2013
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