Healthcare Provider Details

I. General information

NPI: 1356596902
Provider Name (Legal Business Name): CENTERAL ARKANSAS VETERANS HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

IV. Provider business mailing address

2200 FORT ROOTS DR
NORTH LITTLE ROCK AR
72114-1709
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3271
  • Fax:
Mailing address:
  • Phone: 501-257-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number38973
License Number StateAR

VIII. Authorized Official

Name: MRS. LINDA DIANN SMITH
Title or Position: RECREATIONAL THERAPIST
Credential: C.T.R.S
Phone: 501-257-3271