Provider Demographics
NPI:1053010595
Name:VETCORE22
Entity type:Organization
Organization Name:VETCORE22
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-243-9366
Mailing Address - Street 1:5005 WOODSPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9242
Mailing Address - Country:US
Mailing Address - Phone:870-243-9366
Mailing Address - Fax:
Practice Address - Street 1:1903 JEAN DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8949
Practice Address - Country:US
Practice Address - Phone:870-243-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No286500000XHospitalsMilitary HospitalGroup - Multi-Specialty