| Wacgc-logan-booneville | |
|
174 N Welsh Ave Booneville AR 72927-4130 | |
| (479) 452-6650 | |
| (479) 785-9495 |
| Full Name | Wacgc-logan-booneville |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 174 N Welsh Ave, Booneville, Arkansas |
| Authorized Official Name and Position | Aaron L. 'rusti' Holwick (CEO) |
| Authorized Official Contact | 4794526650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wacgc-logan-booneville Po Box 11818 Fort Smith AR 72917-1818 Ph: (479) 452-6650 | Wacgc-logan-booneville 174 N Welsh Ave Booneville AR 72927-4130 Ph: (479) 452-6650 |
| NPI Number | 1457526857 |
|---|---|
| Provider Enumeration Date | 04/25/2008 |
| Last Update Date | 06/06/2024 |
| Certification Date | 06/06/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457526857 | NPI | - | NPPES |
| 137451726 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Wacgc - Logan County - Booneville Sats Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 174 N Welsh Ave, Booneville, AR 72927 Phone: 479-452-6650 Fax: 479-785-9495 |