Healthcare Provider Details

I. General information

NPI: 1659182673
Provider Name (Legal Business Name): JD'S BRIDGE OF HOPE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15220 KOYLE CEMETERY RD
WINSLOW AR
72959-9062
US

IV. Provider business mailing address

15220 KOYLE CEMETERY RD
WINSLOW AR
72959-9062
US

V. Phone/Fax

Practice location:
  • Phone: 479-283-4939
  • Fax: 870-782-2874
Mailing address:
  • Phone: 479-283-4939
  • Fax: 870-782-2874

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: AMY M DAVIS
Title or Position: FOUNDER AND CEO
Credential:
Phone: 479-283-4939