Provider Demographics
NPI:1659980159
Name:HEALING HANDS ADDICTION CENTERS LLC
Entity Type:Organization
Organization Name:HEALING HANDS ADDICTION CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCDOUGAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:CADC, CS, PR
Authorized Official - Phone:870-489-7903
Mailing Address - Street 1:614 N MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-1904
Mailing Address - Country:US
Mailing Address - Phone:870-466-4400
Mailing Address - Fax:870-466-4556
Practice Address - Street 1:614 N MARTIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-1904
Practice Address - Country:US
Practice Address - Phone:870-466-4400
Practice Address - Fax:870-466-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty