Most Relevant Information
Provider Data
| NPI Number: | 1003203332 |
| Provider Name: | JIMI HENDERSON RECOVERY ASSISTANT |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/24/2015 |
| Last Updated: | 11/08/2021 |
Provider Practice Location
132 LOWER RIDGE RD
CONWAY
AR
720328518
Practice Location Phone/Fax
| Phone: | 5015489905 |
| Fax: |
Provider Mailing Location
PO BOX 1589
BENTON
AR
720181589
Provider Mailing Phone/Fax
| Phone: | 5013153344 |
| Fax: |