Healthcare Provider Details

I. General information

NPI: 1770235996
Provider Name (Legal Business Name): ACHIEVEMENT HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE STE 1711
LITTLE ROCK AR
72201-3436
US

IV. Provider business mailing address

400 W CAPITOL AVE STE 1711
LITTLE ROCK AR
72201-3436
US

V. Phone/Fax

Practice location:
  • Phone: 501-646-6770
  • Fax: 501-421-8409
Mailing address:
  • Phone: 501-646-6770
  • Fax: 501-421-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN HATFIELD
Title or Position: VICE PRESIDENT OPERATIONS
Credential:
Phone: 501-646-6770