Healthcare Provider Details

I. General information

NPI: 1679963243
Provider Name (Legal Business Name): HIGHLANDS OF LITTLE ROCK RILEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 RILEY DR
LITTLE ROCK AR
72205-6509
US

IV. Provider business mailing address

8701 RILEY DR
LITTLE ROCK AR
72205-6509
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-2700
  • Fax: 501-907-0629
Mailing address:
  • Phone: 501-224-2700
  • Fax: 501-907-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BLAINE BRINT
Title or Position: SECRETARY
Credential:
Phone: 205-410-8371