CB King Eudora Center
Organization Active NPI Developmental Disabilities Clinic/Center · Eudora, AR
NPI 1134445422 · NPPES record last updated Apr 13, 2010
Key facts
- NPI
- 1134445422
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Developmental Disabilities Clinic/Center 261QD1600X
- License
- 01923 (AR)
- Legal business name
- CB KING EUDORA CENTER
- Practice address
- 114 N Main St
Eudora, AR 71640-3037 - Phone
- (870) 501-1629
- Fax
- (870) 222-4557
- NPI assigned
- Apr 13, 2010
- Organization subpart
- No
Authorized official
- Name
- Sherry J. Gregory
- Title
- Office Manager
- Phone
- (870) 222-4544
Corporate family (same tax ID) 9
National Provider Directory
- Tax ID family
- CB King Eudora Center
Locations
114 N Main St
Eudora, AR 71640
Phone (870) 501-1629
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Disabilities Clinic/Center | 261QD1600X | 01923 | AR | Yes |
Addresses
Primary practice location
114 N Main St
Eudora, AR 71640-3037
Mailing address
114 N Main St
Eudora, AR 71640-3037
Phone (870) 501-1629
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180546724 | Medicaid | AR |
Other providers in Eudora, AR
All providers in Eudora, AR · Developmental Disabilities Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.