MEDICARE: HEALING HANDS ADDICTION CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1275234122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING HANDS ADDICTION CENTERS LLC

Provider Business Mailing Address
First Line	:	917 MARY B ST STE 8
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	917 MARY B ST STE 8
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1625
Country	:	US
Telephone Number	:	870-466-4400
Fax Number	:	870-466-4556

Authorized Official
Title or Position	:	CEO
Name	:	ROGER ALAN MASON
Credential	:
Telephone Number	:	870-466-4400

Provider Enumeration Date	:	03/16/2023
Last Update Date	:	03/16/2023

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