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General NPI Number Information
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NPI Number | 1841823200
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Entity Type | Organization
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Legal Business Name | THE GREGORY KISTLER TREATMENT CENTER, INC.
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 3304 S M ST
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City | FORT SMITH
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State | AR
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Zip | 72903-2903
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Country | US
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Telephone | 479-785-4677
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Fax | 479-785-4673
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Provider Business Mailing Address
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Address Line | 3304 S M ST
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City | FORT SMITH
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State | AR
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Zip | 72903-2903
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Country | US
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Telephone | 479-785-4677
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Fax | 479-785-4673
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JENNIFER KISTLER
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Credential |
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Telephone | 479-785-4677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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