Healthcare Provider Details

I. General information

NPI: 1285655456
Provider Name (Legal Business Name): CAVHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
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

110 AMBER OAKS DR
SHERWOOD AR
72120-2231
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-3271
  • Fax:
Mailing address:
  • Phone: 501-835-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number25203
License Number StateAR

VIII. Authorized Official

Name: MISS SABRA L WILSON
Title or Position: RECREATIONAL THERPIST
Credential:
Phone: 501-257-3271