Provider Demographics
NPI:1184911471
Name:HRA
Entity type:Organization
Organization Name:HRA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ALCOHOL / DRUG COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:1870-572-3733
Mailing Address - Street 1:2426 HWY 49
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390
Mailing Address - Country:US
Mailing Address - Phone:870-572-3733
Mailing Address - Fax:879-572-3785
Practice Address - Street 1:2426 HWY 49
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390
Practice Address - Country:US
Practice Address - Phone:870-572-3733
Practice Address - Fax:870-572-3785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HRA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization