| 1623 E 42 LLC | |
|
1623 E 42nd St Texarkana AR 71854-1894 | |
| (870) 772-0689 | |
| Not Available |
| Full Name | 1623 E 42 LLC |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1623 E 42nd St, Texarkana, Arkansas |
| Authorized Official Name and Position | Edward V Holman (CEO/PRESIDENT) |
| Authorized Official Contact | 5012240846 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1623 E 42 LLC 10 Shackleford Plz Ste 102 Little Rock AR 72211-1886 Ph: (501) 224-0846 | 1623 E 42 LLC 1623 E 42nd St Texarkana AR 71854-1894 Ph: (870) 772-0689 |
| NPI Number | 1437964244 |
|---|---|
| Provider Enumeration Date | 02/10/2025 |
| Last Update Date | 07/29/2026 |
| Certification Date | 07/29/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437964244 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | () | Primary |
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