Healthcare Provider Details

I. General information

NPI: 1407793896
Provider Name (Legal Business Name): ADDICTION RESOURCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 KIBLER RD
VAN BUREN AR
72956-8407
US

IV. Provider business mailing address

15330 W WAGON TRAIL RD
PARK HILL OK
74451-2145
US

V. Phone/Fax

Practice location:
  • Phone: 918-705-0960
  • Fax:
Mailing address:
  • Phone: 918-705-0960
  • 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: ZACK MODE
Title or Position: OWNER
Credential:
Phone: 918-705-0960