Cossatot Polk County Senior Citizens, Inc.

Primary specialty

Home Delivered MealsTaxonomy code 332U00000X

License

92733 Issued in AR

Legal business name

COSSATOT POLK COUNTY SENIOR CITIZENS, INC.

Practice address

7366 Highway 71 S
Wickes, AR 71973-9341

Phone

(870) 385-2373

Fax

(870) 385-2390

NPI assigned

Apr 22, 2008

Last updated

Apr 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Phyllis J Ray

Title

Executive Director

Phone

(870) 385-2373

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cossatot Senior Center Other name

Locations

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

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1679747513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7366 HIGHWAY 71 S",
            "city": "WICKES",
            "state": "AR",
            "postal_code": "719739341",
            "telephone_number": "870-385-2373",
            "fax_number": "870-385-2390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7366 HIGHWAY 71 S",
            "city": "WICKES",
            "state": "AR",
            "postal_code": "719739341",
            "telephone_number": "870-385-2373",
            "fax_number": "870-385-2390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COSSATOT POLK COUNTY SENIOR CITIZENS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "870-385-2373",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "AR",
            "license": "92733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "160106753",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cossatot Senior Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Rachel Dawn Copeland, RN
• Cossatot River Public Schools
• Patricia Carol Hill, RN
• Meagan Lyle, M.S. SLP, CFY
• Brianna Soto, M.S., CCC-SLP
• Wickes School District

• Home Delivered Meals in Wickes, AR
• Providers in Wickes, AR by specialty
• Home Delivered Meals in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.