Provider Demographics
NPI:1043693492
Name:ADDICTION RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:ADDICTION RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-730-1150
Mailing Address - Street 1:211 W 3RD AVE # 12
Mailing Address - Street 2:200
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-4226
Mailing Address - Country:US
Mailing Address - Phone:870-730-1150
Mailing Address - Fax:870-543-4952
Practice Address - Street 1:211 W 3RD AVE # 12
Practice Address - Street 2:200
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-4226
Practice Address - Country:US
Practice Address - Phone:870-730-1150
Practice Address - Fax:870-543-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-088251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health