Provider Demographics
NPI:1972062842
Name:SPRING OF RENEWAL
Entity type:Organization
Organization Name:SPRING OF RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-463-1327
Mailing Address - Street 1:2401 N CARL ST
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2127
Mailing Address - Country:US
Mailing Address - Phone:501-463-1327
Mailing Address - Fax:501-242-4016
Practice Address - Street 1:6801 ISAACS ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6545
Practice Address - Country:US
Practice Address - Phone:501-463-1327
Practice Address - Fax:501-242-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty