NPI 1215642079
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Practice location
- Address
- 3025 Fountain Dr, Conway, AR 72034-3689
- Phone
- (501) 215-7331
- Mailing address
- 20 S Santa Cruz Ave STE 300, Los Gatos, CA 95030-6827
Authorised official
- Name
- Benjamin Fanger
- Title
- Chairman of Board
- Phone
- (408) 890-6648
Registered specialties
Community/Behavioral Health Agency
Primary
Registry record
- NPI
- 1215642079
- Entity type
- Organization
- NPI issued
- 17 Jan 2023
- Record last updated
- 17 Jan 2023
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.