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100 Rivendell Drive Benton AR 72019 | |
| (501) 316-1255 | |
| (501) 794-0908 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 100 Rivendell Drive, Benton, Arkansas |
| Authorized Official Name and Position | Steve Filton (SR VP CFO) |
| Authorized Official Contact | 6107683300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Rivendell Drive Benton AR 72019 Ph: (501) 316-1255 | 100 Rivendell Drive Benton AR 72019 Ph: (501) 316-1255 |
| NPI Number | 1972673069 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 08/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972673069 | NPI | - | NPPES |
| 152548726 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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