Provider Demographics
NPI:1922675685
Name:CROSS HOPE TREATMENT CENTERS, PLLC
Entity Type:Organization
Organization Name:CROSS HOPE TREATMENT CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-424-2100
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-0470
Mailing Address - Country:US
Mailing Address - Phone:870-424-2100
Mailing Address - Fax:870-424-2323
Practice Address - Street 1:400 S COLLEGE ST STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3991
Practice Address - Country:US
Practice Address - Phone:870-424-2100
Practice Address - Fax:870-424-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty