Provider Demographics
NPI:1780709501
Name:NEWTON COUNTY SPECIAL SERVICE CORP., INC
Entity type:Organization
Organization Name:NEWTON COUNTY SPECIAL SERVICE CORP., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-446-2682
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AR
Mailing Address - Zip Code:72641-0528
Mailing Address - Country:US
Mailing Address - Phone:870-446-2682
Mailing Address - Fax:870-446-5142
Practice Address - Street 1:611 WEST CLARK STREET
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AR
Practice Address - Zip Code:72641-0528
Practice Address - Country:US
Practice Address - Phone:870-446-2682
Practice Address - Fax:870-446-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103607724Medicaid