Provider Demographics
NPI:1740403294
Name:BAXTER DAY SERVICE CENTER, INC.
Entity type:Organization
Organization Name:BAXTER DAY SERVICE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PELTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-425-4322
Mailing Address - Street 1:1631 LEO DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-9661
Mailing Address - Country:US
Mailing Address - Phone:870-425-4322
Mailing Address - Fax:870-424-2313
Practice Address - Street 1:1631 LEO DAVIS DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-9661
Practice Address - Country:US
Practice Address - Phone:870-425-4322
Practice Address - Fax:870-424-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization