Healthcare Provider Details

I. General information

NPI: 1548477268
Provider Name (Legal Business Name): BRANMAT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 HERITAGE DR
NORTH LITTLE ROCK AR
72117-2522
US

IV. Provider business mailing address

PO BOX 6388
NORTH LITTLE ROCK AR
72124-6388
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-3177
  • Fax: 501-945-0219
Mailing address:
  • Phone: 501-945-3177
  • Fax: 501-945-0219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number518
License Number StateAR

VIII. Authorized Official

Name: STEVE SINK
Title or Position: OWNER
Credential:
Phone: 501-945-3177