Healthcare Provider Details

I. General information

NPI: 1962999359
Provider Name (Legal Business Name): NATURAL STATE RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MAIN ST
LITTLE ROCK AR
72202-3818
US

IV. Provider business mailing address

10025 OAKLAND DR
NORTH LITTLE ROCK AR
72118-1942
US

V. Phone/Fax

Practice location:
  • Phone: 501-319-7074
  • Fax: 501-800-1007
Mailing address:
  • Phone: 501-319-7074
  • Fax: 501-800-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateAR

VIII. Authorized Official

Name: GRANT K GORDY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-319-7074