Healthcare Provider Details

I. General information

NPI: 1568588499
Provider Name (Legal Business Name): LIVING HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST
HORATIO AR
71842-8729
US

IV. Provider business mailing address

PO BOX 152
HORATIO AR
71842-0152
US

V. Phone/Fax

Practice location:
  • Phone: 870-582-4319
  • Fax:
Mailing address:
  • Phone: 870-832-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MARIE SHELTON
Title or Position: DISTRICT COORDINATOR
Credential: LCSW
Phone: 903-748-8816