NPIMap

Organization Active NPI

Civitan Center

  • Developmentally Disabled Services Day Training Agency
  • Benton, AR
National Provider Identifier
1508917295
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
CIVITAN CENTER
Practice address
121 South Cox Street
121 South Cox Street
Benton, AR 72018-0368
Phone
(501) 776-0691
Fax
(501) 776-0692
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Leah L. Henderson, MSE-ECSE
Title
Executive Director
Phone
(501) 776-0691

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X AR Primary

Addresses

Primary practice location

121 South Cox Street
121 South Cox Street
Benton, AR 72018-0368

Mailing address

121 South Cox Street
P. O. Box 368
Benton, AR 72018-0368
Phone (501) 776-0691

Other identifiers 6

IdentifierTypeStateIssuer
105505724MedicaidAR
120140715MedicaidAR
116454742MedicaidAR
131841774MedicaidAR
125972767MedicaidAR
132537786OtherARSTATE NONMEDICAID

Other names 1

  • CIVITAN SERVICES Doing business as

National Provider Directory

National Provider Directory

Locations

121 Cox St
Benton, AR 72015
Phone (501) 351-2192

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394409600000",
    "number": "1508917295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 SOUTH COX STREET",
            "address_2": "P. O. BOX 368",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720180368",
            "telephone_number": "501-776-0691",
            "fax_number": "501-776-0692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 SOUTH COX STREET",
            "address_2": "121 SOUTH COX STREET",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720180368",
            "telephone_number": "501-776-0691",
            "fax_number": "501-776-0692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVITAN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2014-03-10",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "LEAH",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "501-776-0691",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSE-ECSE"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105505724",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120140715",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116454742",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131841774",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125972767",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NONMEDICAID",
            "identifier": "132537786",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CIVITAN SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.