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CBK MOTHER GOOSE

Agencies Early Intervention Provider Agency

Provider NPI: 1134482649

Organization Information:
Organization Name:  CBK MOTHER GOOSE
Organization is not Subpart
Authorized Official:  SHERRY JAGGERS GREGORY  OFFICE MANAGER  870-222-4544

Practice Location:
239 SWANIGAN ST  EUDORA, AR 71640-2437 US
Tel: 870-222-4544  Fax: --

Business Mailing Address:
PO BOX 1051  MC GEHEE, AR 71654-1051 US
Tel: 870-222-4544  Fax: 870-222-4557

NPI Information:
NPI: 1134482649
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y252Y00000XAgencies
Early Intervention Provider Agency
AR12009

Other Provider Identifiers:

IssuerNumberStateType
191863724AR05



American Medical Association 2012 taxonomy code information

Code: 252Y00000X

Type:

Classification:



Definition:



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