Basic Information
| Provider Information | |||||||||
| NPI: | 1679196992 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHARED FAMILIES OF NORTHWEST ARKANSAS L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N 8TH ST # 997 | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727563761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792748271 | ||||||||
| FaxNumber: | 4798768636 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 N 20TH PL STE 1 | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727563571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792748271 | ||||||||
| FaxNumber: | 8886240137 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 10/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHILDS | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4792748271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.