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General NPI Number Information
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NPI Number | 1508259169
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Entity Type | Organization
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Legal Business Name | TEEN CHALLENGE RANCH OF NORTHWEST ARKANSAS
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 19856 BOYS HOME RD
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City | MORROW
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State | AR
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Zip | 72749-9714
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Country | US
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Telephone | 479-396-9075
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20
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City | MORROW
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State | AR
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Zip | 72749-0020
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Country | US
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Telephone | 479-439-0279
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | LAURA JONES
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Credential |
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Telephone | 479-396-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | AR
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