Healthcare Provider Details

I. General information

NPI: 1073685459
Provider Name (Legal Business Name): LITTLE ROCK COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205-7100
US

IV. Provider business mailing address

4400 SHUFFIELD DR
LITTLE ROCK AR
72205-7100
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-9300
  • Fax: 501-686-9618
Mailing address:
  • Phone: 501-686-9300
  • Fax: 501-686-9618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS A. GRUNDEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-686-9300