Provider Demographics
NPI: | 1699845818 |
---|---|
Name: | UHS OF BENTON, INC. |
Entity Type: | Organization |
Organization Name: | UHS OF BENTON, INC. |
Other - Org Name: | RIVENDELL BEHAVIORAL HEALTH SERVICES OF ARKANSAS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | SCOTT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WILLIAMS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 501-316-1255 |
Mailing Address - Street 1: | 100 RIVENDELL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BENTON |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72015-9188 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-316-1255 |
Mailing Address - Fax: | 501-794-0908 |
Practice Address - Street 1: | 6210 DOLLARWAY RD |
Practice Address - Street 2: | SUITE 4 |
Practice Address - City: | PINE BLUFF |
Practice Address - State: | AR |
Practice Address - Zip Code: | 71602-3733 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-247-3588 |
Practice Address - Fax: | 870-247-2072 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-08 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |