Provider Demographics
NPI:1194482034
Name:HOLLOW CREEK TREATMENT CENTER LLC
Entity type:Organization
Organization Name:HOLLOW CREEK TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:CIT
Authorized Official - Phone:501-865-3639
Mailing Address - Street 1:4956 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-6102
Mailing Address - Country:US
Mailing Address - Phone:501-865-3639
Mailing Address - Fax:
Practice Address - Street 1:4956 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-6102
Practice Address - Country:US
Practice Address - Phone:501-865-3639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-28
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty