Organization
FULLERTON TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM GRUNDEN (EXECUTIVE DIRECTOR)
(501) 686-9300
Entity
Organization
Contact information
Practice address
4601 WEST 7TH STREET, LITTLE ROCK, AR 72205
(501) 686-9380
Mailing address
4400 SHUFFIELD DR, LITTLE ROCK, AR 72205
(501) 686-9300
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123148726
—
AR
Enumeration date
10/30/2008
Last updated
10/30/2008
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