Healthcare Provider Details

I. General information

NPI: 1376743641
Provider Name (Legal Business Name): VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 OLD WARREN RD
MONTICELLO AR
71655-9713
US

IV. Provider business mailing address

1501 N. UNIVERSITY AVE., SUITE 345
LITTLE ROCK AR
72207-5278
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-9035
  • Fax: 870-367-9038
Mailing address:
  • Phone: 501-666-8195
  • Fax: 501-666-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10071
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA MAHURIN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 501-666-8195