Provider Demographics
NPI:1376793406
Name:DANA'S HOUSE, INC.
Entity Type:Organization
Organization Name:DANA'S HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORNBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-509-1675
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0138
Mailing Address - Country:US
Mailing Address - Phone:870-946-8303
Mailing Address - Fax:870-946-8217
Practice Address - Street 1:108 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-1929
Practice Address - Country:US
Practice Address - Phone:870-509-1675
Practice Address - Fax:870-946-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230911744Medicaid