| NPI | 1780134098 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY STOUT Chairman 870-273-5376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AR 239) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2017-01-12 |