Provider Demographics
NPI:1528274552
Name:CAPSTONE TREATMENT CENTER
Entity type:Organization
Organization Name:CAPSTONE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:HICKMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-729-4479
Mailing Address - Street 1:PO BOX 8241
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-8241
Mailing Address - Country:US
Mailing Address - Phone:501-729-4479
Mailing Address - Fax:501-729-3537
Practice Address - Street 1:120 MEGHAN LN
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081-9302
Practice Address - Country:US
Practice Address - Phone:501-729-4479
Practice Address - Fax:501-729-3537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3245S0500X, 323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR10607OtherBCBS