Provider Demographics
NPI:1205980497
Name:ASCENT ACQUISITIONS CORP-CYPDC
Entity type:Organization
Organization Name:ASCENT ACQUISITIONS CORP-CYPDC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INS BILLING REP
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-819-0232
Mailing Address - Street 1:3012 TURMAN DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8998
Mailing Address - Country:US
Mailing Address - Phone:870-819-0200
Mailing Address - Fax:870-819-0217
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:STE. 201
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-935-9911
Practice Address - Fax:870-935-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160785526Medicaid
AR160746742Medicaid
AR57885OtherARKANSAS BCBS