Healthcare Provider Details

I. General information

NPI: 1023287497
Provider Name (Legal Business Name): SOUTH ARKANSAS SUBSTANCE ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HARGETT DR
EL DORADO AR
71730-6521
US

IV. Provider business mailing address

100 HARGETT DRIVE
EL DORADO AR
71730-6521
US

V. Phone/Fax

Practice location:
  • Phone: 870-881-9301
  • Fax: 870-864-9934
Mailing address:
  • Phone: 870-881-9301
  • Fax: 870-864-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number00031
License Number StateAR

VIII. Authorized Official

Name: MR. PAUL MEASON
Title or Position: DIRECTOR
Credential:
Phone: 870-881-9301