Healthcare Provider Details

I. General information

NPI: 1972740355
Provider Name (Legal Business Name): THE P.A.T. CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 W 12TH ST SUITE 201
LITTLE ROCK AR
72204-2404
US

IV. Provider business mailing address

7107 W 12TH ST SUITE 201
LITTLE ROCK AR
72204-2404
US

V. Phone/Fax

Practice location:
  • Phone: 501-812-5545
  • Fax: 501-812-5546
Mailing address:
  • Phone: 501-812-5545
  • Fax: 501-812-5546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251S00000X
License Number StateAR

VIII. Authorized Official

Name: RONALD KIRBY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 501-812-5545