Healthcare Provider Details

I. General information

NPI: 1710721519
Provider Name (Legal Business Name): BUILDING BETTER LIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 W GAINES ST
MONTICELLO AR
71655-4638
US

IV. Provider business mailing address

PO BOX 939
MONTICELLO AR
71657-0939
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-9434
  • Fax: 870-367-9476
Mailing address:
  • Phone: 870-367-9434
  • Fax: 870-367-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: TONI MOORE
Title or Position: OWNER
Credential:
Phone: 870-224-5212