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General NPI Number Information
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NPI Number | 1780134098
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Entity Type | Organization
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Legal Business Name | H4L RANCH, INC.
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 853 US 63
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City | WALNUT RIDGE
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State | AR
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Zip | 72476
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Country | US
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Telephone | 870-273-5376
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Fax |
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Provider Business Mailing Address
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Address Line | 1996 GREEN 747 ROAD
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City | PARAGOULD
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State | AR
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Zip | 72451
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Country | US
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Telephone | 870-273-5376
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | TONY STOUT
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Credential |
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Telephone | 870-273-5376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 239
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License Number State | AR
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