Healthcare Provider Details

I. General information

NPI: 1114129442
Provider Name (Legal Business Name): PARKVIEW REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 JOHN BARROW RD
LITTLE ROCK AR
72204-3335
US

IV. Provider business mailing address

2600 JOHN BARROW RD
LITTLE ROCK AR
72204-3335
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-4173
  • Fax: 501-224-3815
Mailing address:
  • Phone: 501-224-4173
  • Fax: 501-224-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number673
License Number StateAR

VIII. Authorized Official

Name: MR. EDWARD V HOLMAN
Title or Position: PRESIDENT
Credential:
Phone: 501-224-4173