Provider Demographics
NPI:1831536549
Name:HOT SPRINGS BEHAVIORAL CENTER
Entity type:Organization
Organization Name:HOT SPRINGS BEHAVIORAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMSHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAROON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-623-1007
Mailing Address - Street 1:5001 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8673
Mailing Address - Country:US
Mailing Address - Phone:501-623-1007
Mailing Address - Fax:501-623-2252
Practice Address - Street 1:5001 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8673
Practice Address - Country:US
Practice Address - Phone:501-623-1007
Practice Address - Fax:501-623-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0809072101YM0800X
ARE3165261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M442OtherMEDICARE UNSPECIFIED NUMBER
AR163736001Medicaid
AR5M442OtherMEDICARE UNSPECIFIED NUMBER