Healthcare Provider Details

I. General information

NPI: 1053169300
Provider Name (Legal Business Name): RECOVERY TEAM OF NORTH LITTLE ROCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SMARTHOUSE WAY
NORTH LITTLE ROCK AR
72114-5575
US

IV. Provider business mailing address

2925 10TH AVE N
PALM SPRINGS FL
33461-3000
US

V. Phone/Fax

Practice location:
  • Phone: 561-635-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIRILL VESSELOV
Title or Position: PRESIDENT
Credential:
Phone: 561-461-3791