Healthcare Provider Details

I. General information

NPI: 1114365988
Provider Name (Legal Business Name): CROWLEY'S RIDGE DEVELOPMENT COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6009 C W POST RD
JONESBORO AR
72401-8139
US

IV. Provider business mailing address

6009 C W POST RD
JONESBORO AR
72401-8139
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-0228
  • Fax: 870-910-5689
Mailing address:
  • Phone: 870-932-0228
  • Fax: 870-910-5689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number00124
License Number StateAR

VIII. Authorized Official

Name: JEREMY WOOLDRIDGE
Title or Position: CEO
Credential: LCSW
Phone: 870-932-0228