Healthcare Provider Details

I. General information

NPI: 1184911471
Provider Name (Legal Business Name): HRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 HWY 49
WEST HELENA AR
72390
US

IV. Provider business mailing address

2426 HWY 49
WEST HELENA AR
72390
US

V. Phone/Fax

Practice location:
  • Phone: 870-572-3733
  • Fax: 870-572-3785
Mailing address:
  • Phone: 870-572-3733
  • Fax: 879-572-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE GLENN WILKERSON
Title or Position: ALCOHOL / DRUG COUNSELOR
Credential: CADC
Phone: 18705723733