Provider Demographics
NPI:1336408301
Name:TBA TEXARKANA LLC
Entity Type:Organization
Organization Name:TBA TEXARKANA LLC
Other - Org Name:VISTA HEALTH TEXARKANA RSPMI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-1427
Mailing Address - Street 1:3352 N FUTRALL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4057
Mailing Address - Country:US
Mailing Address - Phone:479-521-1427
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:701 ARKANSAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-2105
Practice Address - Country:US
Practice Address - Phone:870-772-5028
Practice Address - Fax:870-772-2138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMICARE BEHAVIORAL CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251C00000XAgenciesDay Training, Developmentally Disabled Services