NPIMap

Organization Active NPI

Jeremiah Recovery House, Inc.

Doing business as 29 11 Healing and Recovery Center

  • Substance Abuse Rehabilitation Facility
  • Berryville, AR
National Provider Identifier
1366153454
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
JEREMIAH RECOVERY HOUSE, INC.
Doing business as
29 11 Healing and Recovery Center
Practice address
706 Park St
Berryville, AR 72616-3134
Phone
(870) 661-2099
NPI assigned
Dec 8, 2022
Last updated
Dec 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vickie PoulsonNPI 1902197924
Title
Ceo
Phone
(870) 716-9365

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

706 Park St
Berryville, AR 72616-3134

Mailing address

801 W Trimble Ave
Berryville, AR 72616-5101

Other practice location 1

801 W Trimble Ave
Berryville, AR 72616-5101
Phone (870) 716-9365

Other names 1

  • 29 11 HEALING AND RECOVERY CENTER Doing business as

National Provider Directory

National Provider Directory

Locations

706 Park St
Berryville, AR 72616
Phone (870) 661-2099

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764806400000",
    "number": "1366153454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W TRIMBLE AVE",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726165101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 PARK ST",
            "city": "BERRYVILLE",
            "state": "AR",
            "postal_code": "726163134",
            "telephone_number": "870-661-2099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 W Trimble Ave",
            "address_purpose": "LOCATION",
            "city": "Berryville",
            "state": "AR",
            "postal_code": "726165101",
            "country_code": "US",
            "telephone_number": "870-716-9365",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JEREMIAH RECOVERY HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-08",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A",
        "authorized_official_last_name": "POULSON",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-716-9365"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "29 11 HEALING AND RECOVERY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berryville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.