Provider Demographics
NPI:1831816206
Name:RECOVERY CENTERS OF ARKANSAS, INC.
Entity type:Organization
Organization Name:RECOVERY CENTERS OF ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-614-4900
Mailing Address - Street 1:9219 SIBLEY HOLE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-8874
Mailing Address - Country:US
Mailing Address - Phone:501-614-4900
Mailing Address - Fax:501-372-1801
Practice Address - Street 1:6301 FATHER TRIBOU ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3003
Practice Address - Country:US
Practice Address - Phone:501-372-4611
Practice Address - Fax:501-372-1801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY CENTERS OF ARKANSAS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR239221526Medicaid