Healthcare Provider Details

I. General information

NPI: 1487477717
Provider Name (Legal Business Name): IVQ LITTLE ROCK OPCO LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 ALDERSGATE RD
LITTLE ROCK AR
72205-7205
US

IV. Provider business mailing address

1734 GILSINN LN
FENTON MO
63026-2004
US

V. Phone/Fax

Practice location:
  • Phone: 501-260-7407
  • Fax:
Mailing address:
  • Phone: 314-440-2781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TYLER SCOTT BRADY
Title or Position: CFO
Credential:
Phone: 314-440-2781