Organization · NPI-2
Tba Texarkana LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) · Texarkana, AR
NPI number1336408301
StatusActive
Last updated in NPPESMay 11, 2012
Details
- NPI
- 1336408301
- Entity type
- Organization (NPI-2)
- Legal business name
- Tba Texarkana LLC
- Organization subpart
- Yes
- Enumeration date
- May 11, 2012
- Last updated
- May 11, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
| 251C00000X | Day Training, Developmentally Disabled Services | – | – |
Other names
- Vista Health Texarkana Rspmi (Doing Business As)
Practice location
701 Arkansas BlvdTexarkana, AR 71854-2105
Phone 870-772-5028 · Fax 870-772-2138
Mailing address
3352 N Futrall DrFayetteville, AR 72703-4057
Phone 479-521-1427 · Fax 479-521-6520
Authorized official
Kyle Naples
Ceo
4795211427
Is something wrong?
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