Healthcare Provider Details

I. General information

NPI: 1508410648
Provider Name (Legal Business Name): HEAVEN SENT ADULT DAYCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INNWOOD CIR STE 110
LITTLE ROCK AR
72211-2499
US

IV. Provider business mailing address

5 INNWOOD CIR STE 110
LITTLE ROCK AR
72211-2499
US

V. Phone/Fax

Practice location:
  • Phone: 501-313-2961
  • Fax: 501-904-2196
Mailing address:
  • Phone: 501-313-2961
  • Fax: 501-904-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: LYNN DANETTE WALLS
Title or Position: RN/ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 501-313-2961