Healthcare Provider Details

I. General information

NPI: 1114834181
Provider Name (Legal Business Name): HUMBLE BEGINNINGS OF NWA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PARK ST APT B
SPRINGDALE AR
72764-4658
US

IV. Provider business mailing address

309 PARK ST APT B
SPRINGDALE AR
72764-4658
US

V. Phone/Fax

Practice location:
  • Phone: 309-430-7823
  • Fax:
Mailing address:
  • Phone: 309-430-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN N GAUSE
Title or Position: EXERTIVE DIRECTOR
Credential: CIT
Phone: 309-430-7823