| Malvern Branch | |
|
1628 E Page Ave Malvern AR 72104-4524 | |
| (501) 332-4437 | |
| Not Available |
| Full Name | Malvern Branch |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1628 E Page Ave, Malvern, Arkansas |
| Authorized Official Name and Position | Rolando Garcia (CFO) |
| Authorized Official Contact | 5013153344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Malvern Branch 1628 E Page Ave Malvern AR 72104-4524 Ph: (501) 332-4437 | Malvern Branch 1628 E Page Ave Malvern AR 72104-4524 Ph: (501) 332-4437 |
| NPI Number | 1316197304 |
|---|---|
| Provider Enumeration Date | 09/25/2008 |
| Last Update Date | 04/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316197304 | NPI | - | NPPES |
| 116374726 | Medicaid | AR | |
| 171625526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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