Healthcare Provider Details

I. General information

NPI: 1265663702
Provider Name (Legal Business Name): CITY OF FIRE COMMUNITY DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 GEYER SPRINGS RD
LITTLE ROCK AR
72209-4946
US

IV. Provider business mailing address

8300 GEYER SPRINGS RD
LITTLE ROCK AR
72209-4946
US

V. Phone/Fax

Practice location:
  • Phone: 501-682-7550
  • Fax: 501-682-7577
Mailing address:
  • Phone: 501-682-7550
  • Fax: 501-682-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number6044700
License Number StateAR

VIII. Authorized Official

Name: DR. VALERIE LASHELL TATUM
Title or Position: SUPERINTENDENT
Credential: PH.D
Phone: 501-682-7550