Healthcare Provider Details

I. General information

NPI: 1265448468
Provider Name (Legal Business Name): CAVHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 RED BUD CV
BENTON AR
72015-4779
US

IV. Provider business mailing address

2307 REDBUD COVE
BENTON AR
72015-4779
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-2969
  • Fax:
Mailing address:
  • Phone: 501-315-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberP01150
License Number StateAR

VIII. Authorized Official

Name: MRS. JANICE A. ALLEN
Title or Position: RNP
Credential: RNP
Phone: 501-257-6850