Provider Demographics
NPI:1205001088
Name:HOLDEN PSYCHIATRIC INSTITUTE, PA
Entity Type:Organization
Organization Name:HOLDEN PSYCHIATRIC INSTITUTE, PA
Other - Org Name:HOLDEN INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-367-2552
Mailing Address - Street 1:2200 SE J ST STE 12
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4186
Mailing Address - Country:US
Mailing Address - Phone:479-367-2552
Mailing Address - Fax:479-367-2584
Practice Address - Street 1:2200 SE J ST STE 14
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4186
Practice Address - Country:US
Practice Address - Phone:147-936-7255
Practice Address - Fax:479-367-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100080220AMedicaid
AR118344001Medicaid
MO1891880373Medicaid