DERWIN CLARK (NPI# 1508231085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508231085 |
| Entity Type | Individual |
| Full Name | DERWIN CLARK |
| Practice Address |
20400 Colonel Glenn Rd Little Rock AR 72210-5323 |
| Practice Telephone | 5018215500 |
| Practice Fax Number | 5018215580 |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| Street Address |
20400 COLONEL GLENN RD |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72210-5323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942266879 | Youth Home Inc | Community/Behavioral Health | 20400 Colonel Glenn Rd, Little Rock, AR 72210 | 2006-04-20 |
| 1992306385 | Ashley Pankey | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-11-03 |
| 1881295434 | Kyler Smith | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-11-02 |
| 1366040032 | Caleb Mccrary | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-10-14 |
| 1316545080 | Sejames Humphrey | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-10-14 |
| 1316545395 | Andreia Crawford | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-10-13 |
| 1710594569 | Hannah Leigh Eldred | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-09-25 |
| 1922615723 | Stephen Beck | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-09-25 |
| 1356958367 | Tamia Bennett | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-09-24 |
| 1639786643 | Reagan Bell | Counselor | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2020-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487290888 | John Hunter Bramlitt | Counselor | 12320 I-30, Little Rock, AR 72210 | 2019-11-20 |
| 1972159267 | Arkansas Baptist Children's Homes and Family Ministries | Counselor | 12400 I-30, Little Rock, AR 72210 | 2019-08-13 |
| 1952956864 | Hanrietta Evans | Behavior Technician | Youth Home Inc, 20302 Colonel Glenn Rd, Little Rock, AR 72210 | 2019-08-07 |
| 1821597287 | Deanna Smith | Counselor | 12320 I-30 Frontage Road, Little Rock, AR 72210 | 2018-02-12 |
| 1922485481 | Whitney Brown | Social Worker | 20400 Colonel Glenn, Little Rock, AR 72210 | 2015-05-04 |
| 1679978191 | Jennifer Black | Counselor | 20302 Col Glenn Road, Little Rock, AR 72210 | 2014-10-27 |
| 1831593896 | James William Takach | Family Medicine | 14519 Wimbledon Loop, Little Rock, AR 72210 | 2014-10-20 |
| 1811319734 | Ben Malone | Case Manager/Care Coordinator | 20400 Col Glenn Road, Little Rock, AR 72210 | 2014-01-12 |
| 1487924296 | Tara Brown | Case Manager/Care Coordinator | 20302 Colonel Glenn Rd., Little Rock, AR 72210 | 2012-01-10 |
| 1972889061 | D. Rachelle Rial | Case Manager/Care Coordinator | 20400 Col Glenn Rd., Little Rock, AR 72210 | 2011-11-02 |
| Find all providers in zip 72210 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326232240 | Youth Home Incorporated | Residential Treatment Facility, Emotionally Disturbed Children | 5109 W 23rd St, Little Rock, AR 72204-5101 | 2007-09-04 |
| 1326116518 | United Methodist Children's Home, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 2002 S Fillmore St, Little Rock, AR 72204-4909 | 2006-12-04 |
| 1437517844 | David Zajac | Residential Treatment Facility, Emotionally Disturbed Children | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2016-02-01 |
| 1104282235 | Cedric Mayo | Residential Treatment Facility, Emotionally Disturbed Children | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2016-01-05 |
| 1477928984 | Kelanda Williams | Residential Treatment Facility, Emotionally Disturbed Children | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2015-12-09 |
| 1932574431 | Felicia Reynolds-johnson | Residential Treatment Facility, Emotionally Disturbed Children | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2015-12-09 |
| 1174763536 | United Methodist Children's Home | Residential Treatment Facility, Emotionally Disturbed Children | 1600 Aldersgate Rd, Suite 200, Little Rock, AR 72205-6614 | 2009-02-25 |
| 1134397276 | Centers for Youth and Families, Inc | Residential Treatment Facility, Emotionally Disturbed Children | 6501 W 12th St, Little Rock, AR 72204-1511 | 2008-02-12 |
| 1649458514 | Centers for Youth and Families | Residential Treatment Facility, Emotionally Disturbed Children | 6501 W 12th St, Little Rock, AR 72204-1511 | 2008-02-04 |
| 1891901955 | Youth Home Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 20400 Colonel Glenn Rd, Little Rock, AR 72210-5323 | 2007-05-15 |
| Find all providers in LITTLE ROCK | ||||
| City | LITTLE ROCK |
| Zip Code | 72210 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.