Organization
EAGLECREST RECOVERY LLC
Active
Parent organization
EAGLECREST RECOVERY LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAGLECREST RECOVERY LLC
Authorized official
JUAN F HERNANDEZ (CEO)
(949) 813-5161
Entity
Organization
Contact information
Practice address
1106 SW 2ND ST, BENTONVILLE, AR 72712-5026
(479) 367-2691
(479) 367-2899
Mailing address
1101 SW COVENTRY BLVD, BENTONVILLE, AR 72712-4325
(479) 367-2691
(479) 367-2899
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/16/2019
Last updated
05/19/2020
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