Basic Information
| Provider Information | |||||||||
| NPI: | 1902372774 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOMETOWN BEHAVIORAL HEALTH SERVICES OF ARKANSAS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 299 | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724330299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708861333 | ||||||||
| FaxNumber: | 8708861334 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726534423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707015141 | ||||||||
| FaxNumber: | 8707015177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2018 | ||||||||
| LastUpdateDate: | 04/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | PRONDZINSKI | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8708861333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOMETOWN BEHAVIORAL HEALTH SERVICES OF ARKANSAS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.