NPIMap

Organization Active NPI

Conway County Community Service Inc

  • Community/Behavioral Health Agency
  • Clinton, AR
National Provider Identifier
1962637082
Registry record updated Mar 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CONWAY COUNTY COMMUNITY SERVICE INC
Practice address
119 Shake Rag Rd
Clinton, AR 72031-6682
Phone
(501) 745-2956
Fax
(501) 745-6918
NPI assigned
May 19, 2009
Last updated
Mar 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2021

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

Authorized official

Name
Angela Lynn Wheat
Title
PA/Credentialing Clerk
Phone
(501) 354-4589

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

119 Shake Rag Rd
Clinton, AR 72031-6682

Mailing address

P.O. Box 1133
Clinton, AR 72031
Phone (501) 745-2956

Other names 1

  • Community Service Inc. - Clinton Other name

National Provider Directory

National Provider Directory
Tax ID family
Conway County Comm Serv Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

119 Shake Rag Rd
Clinton, AR 72031
Phone (501) 745-2956

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1242691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1962637082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1133",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "72031",
            "telephone_number": "501-745-2956",
            "fax_number": "501-745-2956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SHAKE RAG RD",
            "city": "CLINTON",
            "state": "AR",
            "postal_code": "720316682",
            "telephone_number": "501-745-2956",
            "fax_number": "501-745-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONWAY COUNTY COMMUNITY SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-19",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "WHEAT",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PA/CREDENTIALING CLERK",
        "authorized_official_telephone_number": "501-354-4589"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Service Inc. - Clinton",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Service Inc. - Clinton",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clinton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; 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.