Provider Demographics
NPI:1205454808
Name:INCURA, INC.
Entity type:Organization
Organization Name:INCURA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-672-1038
Mailing Address - Street 1:7481 WARDEN RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5041
Mailing Address - Country:US
Mailing Address - Phone:501-747-1731
Mailing Address - Fax:501-897-6195
Practice Address - Street 1:7481 WARDEN RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5041
Practice Address - Country:US
Practice Address - Phone:501-747-1731
Practice Address - Fax:501-897-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility