Healthcare Provider Details

I. General information

NPI: 1548325251
Provider Name (Legal Business Name): AMERIS OF ARKANSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N DIVISION ST
BLYTHEVILLE AR
72315-1448
US

IV. Provider business mailing address

PO BOX 167
BLYTHEVILLE AR
72316-0167
US

V. Phone/Fax

Practice location:
  • Phone: 870-838-7213
  • Fax: 870-838-7100
Mailing address:
  • Phone: 870-838-7213
  • Fax: 870-838-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberAR4258
License Number StateAR

VIII. Authorized Official

Name: DAVID LYNN
Title or Position: CFO
Credential:
Phone: 870-838-7462