=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881251510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESHLY RENEWED TRANSITIONAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2019
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8404 BASELINE RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72209-4339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-663-0708
-----------------------------------------------------
Fax | 501-313-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 LOUISIANA DOWNS CV
-----------------------------------------------------
City | SCOTT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72142-9719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-944-1406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. TERRELL NEWTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-944-1406
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------