| NPI | 1265040398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE ACKERSON CEO 870-448-5733 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2020-07-15 |