5 RESIDENTIAL LLC — NPI 1104398460 (Licensed & Credentialed Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children in JONESBORO, AR)

CMS-1500 Box 24J / 33a • NPI

1104398460

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

3245S0500X

Licensed & Credentialed Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children

Box 32 Service Location & ZIP+4

2209 GRANT AVE STE A, JONESBORO, AR, 72401-6195

✓ 9-Digit EDI 837 ZIP+4 (72401-6195)

Practice Phone & Referral Fax

(870) 333-5300

Fax: (870) 333-5301

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104398460 (5 RESIDENTIAL LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104398460` (NPI-2 Organization / Facility)
Provider / Legal Name	5 RESIDENTIAL LLC
Plain-English Specialty	Licensed & Credentialed Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children NUCC Code: `3245S0500X` (Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2209 GRANT AVE STE A, JONESBORO, AR, 72401-6195
Practice Telephone / Fax	Tel: (870) 333-5300 \| Fax: (870) 333-5301
Administrative Mailing Address	2209 GRANT AVE STE A, JONESBORO, AR, 72401-6195
Enumeration & Last Sync	Enumerated: 2018-12-27 \| CMS Record Updated: 2018-12-27
Authorized Official	BEAU EAVES (CFO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2209 GRANT AVE STE A, JONESBORO, AR, 72401-6195

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Plain-English Taxonomy & CMS Crosswalk (3245S0500X)

What Does Taxonomy Code 3245S0500X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3245S0500X translates to:
"Licensed & Credentialed Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (5 RESIDENTIAL LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`3245S0500X` — Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children Plain English: Licensed & Credentialed Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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5 RESIDENTIAL LLC (NPI #1104398460)