Healthcare Provider Details

I. General information

NPI: 1568256477
Provider Name (Legal Business Name): MOUNTAINBURG OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18502 CARTWRIGHT MOUNTAIN ROAD
MOUNTAINBURG AR
72946
US

IV. Provider business mailing address

18502 CARTWRIGHT MOUNTAIN ROAD
MOUNTAINBURG AR
72946
US

V. Phone/Fax

Practice location:
  • Phone: 479-619-7761
  • Fax:
Mailing address:
  • Phone: 479-619-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ARONICA REED
Title or Position: C.O.O.
Credential:
Phone: 479-619-7761