Healthcare Provider Details

I. General information

NPI: 1285273219
Provider Name (Legal Business Name): TRUE SELF RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 N 2ND ST
ROGERS AR
72756-2834
US

IV. Provider business mailing address

1104 N 2ND ST
ROGERS AR
72756-2834
US

V. Phone/Fax

Practice location:
  • Phone: 479-337-4672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: WILL BURSE
Title or Position: OWNER
Credential:
Phone: 479-335-5999