Provider Demographics
NPI:1508259169
Name:TEEN CHALLENGE RANCH OF NORTHWEST ARKANSAS
Entity Type:Organization
Organization Name:TEEN CHALLENGE RANCH OF NORTHWEST ARKANSAS
Other - Org Name:TEEN CHALLENGE ADVENTURE RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-396-9075
Mailing Address - Street 1:PO BOX 20
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:AR
Mailing Address - Zip Code:72749-0020
Mailing Address - Country:US
Mailing Address - Phone:479-439-0279
Mailing Address - Fax:
Practice Address - Street 1:19856 BOYS HOME RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:AR
Practice Address - Zip Code:72749-9714
Practice Address - Country:US
Practice Address - Phone:479-396-9075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR322D00000X, 324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility