Provider Demographics
NPI:1235375734
Name:HEALTH RESOURCES OF ARKANSAS, INC.
Entity Type:Organization
Organization Name:HEALTH RESOURCES OF ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-8900
Mailing Address - Street 1:25 GAP RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8679
Mailing Address - Country:US
Mailing Address - Phone:870-994-2106
Mailing Address - Fax:870-994-7868
Practice Address - Street 1:714 ASH FLAT DR
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513
Practice Address - Country:US
Practice Address - Phone:870-994-2106
Practice Address - Fax:870-994-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57072Medicare PIN