Provider Demographics
NPI:1104033976
Name:AMERIS OF ARKANSAS, LLC
Entity Type:Organization
Organization Name:AMERIS OF ARKANSAS, LLC
Other - Org Name:GREAT RIVER RESIDENTIAL ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-4440
Mailing Address - Street 1:1114 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2215
Mailing Address - Country:US
Mailing Address - Phone:615-327-4440
Mailing Address - Fax:615-327-0898
Practice Address - Street 1:611 W LEE AVE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3001
Practice Address - Country:US
Practice Address - Phone:870-563-7000
Practice Address - Fax:870-838-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR20102323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARBEING APPLIED FORMedicaid