Provider Demographics
NPI:1104398460
Name:5 RESIDENTIAL LLC
Entity Type:Organization
Organization Name:5 RESIDENTIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-273-2096
Mailing Address - Street 1:2209 GRANT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2209 GRANT AVE STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6195
Practice Address - Country:US
Practice Address - Phone:870-333-5300
Practice Address - Fax:870-333-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children