Healthcare Provider Details

I. General information

NPI: 1972673069
Provider Name (Legal Business Name): UHS OF BENTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVENDELL DRIVE
BENTON AR
72019
US

IV. Provider business mailing address

100 RIVENDELL DRIVE
BENTON AR
72019
US

V. Phone/Fax

Practice location:
  • Phone: 501-316-1255
  • Fax: 501-794-0908
Mailing address:
  • Phone: 501-316-1255
  • Fax: 501-794-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300