Healthcare Provider Details

I. General information

NPI: 1447439708
Provider Name (Legal Business Name): BAPTIST HEALTH EXTENDED CARE HOSPITAL - LITTLE ROCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DRIVE 10TH FLOOR
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

9601 BAPTIST HEALTH DRIVE 10TH FLOOR
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-6000
  • Fax:
Mailing address:
  • Phone: 501-202-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberAR4489
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberAR4489
License Number StateAR

VIII. Authorized Official

Name: TROY WELLS
Title or Position: PRESIDENT
Credential:
Phone: 501-202-2080