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PINEY RIDGE TREATMENT CENTER LLC NPI 1447380423


NPI Information

NPI: 1447380423
Provider Name: PINEY RIDGE TREATMENT CENTER, LLC
Classification: Psychiatric Residential Treatment Facility - 323P00000X
Entity Type: Organization

CLIA Number: 04D1071444

Address:
4253 CROSSOVER RD
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 587-1408
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PINEY RIDGE TREATMENT CENTER, LLC is a psychiatric residential treatment facility in Fayetteville, AR. The provider is a residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary PINEY RIDGE TREATMENT CENTER, LLC NPI is 1447380423. The provider is registered as an organization entity type.

The provider's business location address is:

4253 CROSSOVER RD
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 587-1408
Fax: (489) 684-1323

The provider's authorized official is Christopher L Howard .
The authorized official title is Vp & Secretary and has the following contact phone number (615) 861-6000.

The CLIA number assigned to this NPI record is 04D1071444 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/7/2007 and was last updated on 10/17/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1323P00000XPsychiatric Residential Treatment FacilityARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1162602125MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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