Organization
THE GREGORY KISTLER TREATMENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER KISTLER (EXECUTIVE DIRECTOR)
(479) 785-4677
Entity
Organization
Contact information
Practice address
3304 S M ST, FORT SMITH, AR 72903-2903
(479) 785-4677
(479) 785-4673
Mailing address
3304 S M ST, FORT SMITH, AR 72903-2903
(479) 785-4677
(479) 785-4673
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000679370D
—
OK
05
—
115951742
—
AR
05
—
117606716
—
AR
01
—
47953
BCBS DME
AR
01
—
5B311
BCBS TREATMENT
AR
Enumeration date
03/21/2006
Last updated
08/13/2012
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