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Organization

SHORT MOUNTAIN LODGE CSSP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CLAUDE BRYANT (REGIONAL ADMINISTRATOR)
(479) 650-7083
Entity
Organization

Contact information

Practice address
2721 W WALNUT ST, PARIS, AR 72855-3642
(479) 963-2255
Mailing address
6500 RYE HILL RD E, FORT SMITH, AR 72916-8397
(479) 650-7083

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

Other

Enumeration date
11/20/2024
Last updated
05/07/2025
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