| Freshly Renewed Transitional | |
|
8404 Baseline Rd Little Rock AR 72209-4339 | |
| (501) 733-5413 | |
| Not Available |
| Full Name | Freshly Renewed Transitional |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 8404 Baseline Rd, Little Rock, Arkansas |
| Authorized Official Name and Position | Terrell Newton (OWNER) |
| Authorized Official Contact | 5019441406 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Freshly Renewed Transitional 12 Louisiana Downs Cv Scott AR 72142-9719 Ph: (501) 944-1406 | Freshly Renewed Transitional 8404 Baseline Rd Little Rock AR 72209-4339 Ph: (501) 733-5413 |
| NPI Number | 1881251510 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 09/01/2021 |
| Certification Date | 09/01/2021 |
| Medicare PECOS PAC ID | 9436544574 |
|---|---|
| Medicare Enrollment ID | O20220328000970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881251510 | NPI | - | NPPES |
| Provider Name | Althea T Conley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114995198 PECOS PAC ID: 7517851413 Enrollment ID: I20040819000963 |
| Provider Name | Marsha R Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801163563 PECOS PAC ID: 5597072611 Enrollment ID: I20150922000598 |
| Provider Name | Beth L Craft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962630947 PECOS PAC ID: 3375550635 Enrollment ID: I20180302000960 |
| Provider Name | Tiara L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528352366 PECOS PAC ID: 1658785894 Enrollment ID: I20210128002156 |
| Provider Name | Angie Watson-griffin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275960700 PECOS PAC ID: 7810392529 Enrollment ID: I20220214002231 |
| Provider Name | Dede R Lowe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801171079 PECOS PAC ID: 7517315674 Enrollment ID: I20231129003482 |
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