Provider Demographics
NPI:1194615732
Name:UNION RESCUE MISSION INCORPORATED
Entity type:Organization
Organization Name:UNION RESCUE MISSION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-370-0808
Mailing Address - Street 1:PO BOX 164057
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72216-4057
Mailing Address - Country:US
Mailing Address - Phone:501-370-0808
Mailing Address - Fax:501-353-0714
Practice Address - Street 1:3001 SPRINGER BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-3313
Practice Address - Country:US
Practice Address - Phone:501-370-0808
Practice Address - Fax:501-370-0808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION RESCUE MISSION INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder