Provider Demographics
NPI:1932234960
Name:WILBUR D. MILLS TREATMENT CENTER
Entity Type:Organization
Organization Name:WILBUR D. MILLS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:501-268-7777
Mailing Address - Street 1:3204 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4826
Mailing Address - Country:US
Mailing Address - Phone:501-268-7777
Mailing Address - Fax:501-305-5009
Practice Address - Street 1:3204 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4826
Practice Address - Country:US
Practice Address - Phone:501-268-7777
Practice Address - Fax:501-305-5009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH RESOURCES OF ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-22
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10562OtherBLUE CROSS BLUE SHIELD ID