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RUSSELL BORLAND MHPP

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1215186291

Individual Registrant:
 RUSSELL  BORLAND MHPP
Gender: M
Not Sole Proprietor

Location and contact information for practice:
400 E HIGHWAY 43  HARRISON, AR 72601-6514 US
Tel: 870-391-3871  Fax: 870-391-3874

Contact information for business:
4253 N CROSSOVER RD  FAYETTEVILLE, AR 72703-4593 US
Tel: 479-521-5731  Fax: 479-521-6520

Registration Information:
NPI: 1215186291
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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