Organization
RESURGENT MHT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD E WLEKLINSKI APRN (OWNER)
(479) 220-2772
Entity
Organization
Contact information
Practice address
593 S HORSEBARN RD, ROGERS, AR 72758-8795
(479) 657-4636
Mailing address
324 RAVENWOOD RD, SILOAM SPRINGS, AR 72761-5550
(479) 220-2772
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
A003818
AR
261QM0855X
Adolescent and Children Mental Health Clinic/Center
A003818
AR
Other
Enumeration date
04/08/2016
Last updated
04/08/2016
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