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General NPI Number Information
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NPI Number | 1528274552
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Entity Type | Organization
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Legal Business Name | CAPSTONE TREATMENT CENTER
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 120 MEGHAN LN
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City | JUDSONIA
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State | AR
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Zip | 72081-9302
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Country | US
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Telephone | 501-729-4479
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Fax | 501-729-3537
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Provider Business Mailing Address
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Address Line | PO BOX 8241
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City | SEARCY
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State | AR
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Zip | 72145-8241
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Country | US
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Telephone | 501-729-4479
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Fax | 501-729-3537
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | WILLIAM ADRIAN HICKMON
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Credential | PH.D.
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Telephone | 501-729-4479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment 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 | 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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