Healthcare Provider Details

I. General information

NPI: 1386914844
Provider Name (Legal Business Name): JLM VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REMINGTON COVE
LITTLE ROCK AR
72204-8202
US

IV. Provider business mailing address

5 REMINGTON COVE
LITTLE ROCK AR
72204-8202
US

V. Phone/Fax

Practice location:
  • Phone: 501-850-8788
  • Fax: 501-850-8791
Mailing address:
  • Phone: 501-850-8788
  • Fax: 501-850-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number27994
License Number StateAR

VIII. Authorized Official

Name: MELISSA W THOMAS
Title or Position: VP OF CLINIC OPERATIONS/SLP
Credential: M.S., CCC/SLP
Phone: 501-850-8788