| Spring Of Renewal | |
|
302 S Main St Malvern AR 72104-3737 | |
| (501) 463-1327 | |
| Not Available |
| Full Name | Spring Of Renewal |
|---|---|
| Speciality | Social Worker |
| Location | 302 S Main St, Malvern, Arkansas |
| Authorized Official Name and Position | Angela D Moses (SOCIAL WORKER) |
| Authorized Official Contact | 5014631327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spring Of Renewal 2401 N Carl St Siloam Springs AR 72761-2127 Ph: (501) 463-1327 | Spring Of Renewal 302 S Main St Malvern AR 72104-3737 Ph: (501) 463-1327 |
| NPI Number | 1972062842 |
|---|---|
| Provider Enumeration Date | 03/19/2019 |
| Last Update Date | 06/12/2023 |
| Certification Date | 06/12/2023 |
| Medicare PECOS PAC ID | 0345570271 |
|---|---|
| Medicare Enrollment ID | O20190919001316 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972062842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Angela D Moses |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356645436 PECOS PAC ID: 8123387495 Enrollment ID: I20180111002069 |
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