Provider Demographics
NPI:1447518865
Name:HENRY WRINKLES FOUNDATION
Entity type:Organization
Organization Name:HENRY WRINKLES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:BSE
Authorized Official - Phone:870-586-9229
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72412-0672
Mailing Address - Country:US
Mailing Address - Phone:870-586-9229
Mailing Address - Fax:
Practice Address - Street 1:6872 HIGHWAY 34 W
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7644
Practice Address - Country:US
Practice Address - Phone:870-586-9229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty