Provider Demographics
NPI:1902443229
Name:QUAPAW HOUSE
Entity Type:Organization
Organization Name:QUAPAW HOUSE
Other - Org Name:QUAPAW HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/ CLAIMS SPEC.
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-204-8186
Mailing Address - Street 1:505 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-3931
Mailing Address - Country:US
Mailing Address - Phone:501-623-3700
Mailing Address - Fax:
Practice Address - Street 1:615 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3927
Practice Address - Country:US
Practice Address - Phone:501-609-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:QUAPAW HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-05
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5G217OtherBCBS