Healthcare Provider Details

I. General information

NPI: 1366530883
Provider Name (Legal Business Name): CENTRAL ARKANSAS VETERANS HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 WEST CHARLES BUSSEY AVE.
LITTLE ROCK AR
72206
US

IV. Provider business mailing address

1321 W CHARLES BUSSEY AVE
LITTLE ROCK AR
72206-1116
US

V. Phone/Fax

Practice location:
  • Phone: 501-374-3859
  • Fax:
Mailing address:
  • Phone: 501-374-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number1766-M
License Number StateAR

VIII. Authorized Official

Name: LOUIS LEFEBVRE
Title or Position: DOMICILLARY CHIEF
Credential: LCSW
Phone: 501-257-2311