Provider Demographics
NPI:1861615429
Name:ASHLEY COUNTY SKILLED WORKCENTER, INC.
Entity type:Organization
Organization Name:ASHLEY COUNTY SKILLED WORKCENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-364-9253
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-0900
Mailing Address - Country:US
Mailing Address - Phone:870-364-9253
Mailing Address - Fax:870-364-9243
Practice Address - Street 1:208 N ARKANSAS ST
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2836
Practice Address - Country:US
Practice Address - Phone:870-364-9253
Practice Address - Fax:870-364-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112575724Medicaid