Provider Demographics
NPI:1679866149
Name:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:MID SOUTH HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4939
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:507 MISSOURI
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-3731
Practice Address - Country:US
Practice Address - Phone:870-338-3434
Practice Address - Fax:870-338-3997
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-17
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
AR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184165767Medicaid
AR184165767Medicaid