Healthcare Provider Details

I. General information

NPI: 1184792830
Provider Name (Legal Business Name): THE ACADEMY AT RIVERDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BROOKWOOD DR
LITTLE ROCK AR
72202-1704
US

IV. Provider business mailing address

1600 BROOKWOOD DR
LITTLE ROCK AR
72202-1704
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-6965
  • Fax: 501-603-0675
Mailing address:
  • Phone: 501-663-6965
  • Fax: 501-603-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOYCE PATTILLO
Title or Position: DIRECTOR
Credential:
Phone: 501-663-6965