Healthcare Provider Details

I. General information

NPI: 1508259169
Provider Name (Legal Business Name): TEEN CHALLENGE RANCH OF NORTHWEST ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19856 BOYS HOME RD
MORROW AR
72749-9714
US

IV. Provider business mailing address

PO BOX 20
MORROW AR
72749-0020
US

V. Phone/Fax

Practice location:
  • Phone: 479-396-9075
  • Fax:
Mailing address:
  • Phone: 479-439-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateAR

VIII. Authorized Official

Name: LAURA JONES
Title or Position: BILLING MANAGER
Credential:
Phone: 479-396-9075