Provider Demographics
NPI:1750670303
Name:OZARK MOUNTAIN ALCOHOL RESIDENTIAL TREATMENT, INC,.
Entity Type:Organization
Organization Name:OZARK MOUNTAIN ALCOHOL RESIDENTIAL TREATMENT, INC,.
Other - Org Name:OMART, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRINE
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:870-435-6200
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:GASSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72635-0188
Mailing Address - Country:US
Mailing Address - Phone:870-435-6200
Mailing Address - Fax:
Practice Address - Street 1:116 SNOWBALL DR
Practice Address - Street 2:
Practice Address - City:GASSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72635
Practice Address - Country:US
Practice Address - Phone:870-435-6200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR00059324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD14714OtherSTATE OF ARKANSAS OFFICE OF ALCOHOL AND DRUG ABUSE PREVENTION