Healthcare Provider Details

I. General information

NPI: 1346571163
Provider Name (Legal Business Name): GVAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E 42ND ST
TEXARKANA AR
71854-1654
US

IV. Provider business mailing address

10 SHACKLEFORD PLZ STE 102
LITTLE ROCK AR
72211-1886
US

V. Phone/Fax

Practice location:
  • Phone: 870-772-0689
  • Fax: 870-772-1103
Mailing address:
  • Phone: 501-224-0846
  • Fax: 501-224-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number485
License Number StateAR

VIII. Authorized Official

Name: EDWARD V. HOLMAN
Title or Position: PRESIDENT
Credential:
Phone: 501-224-0846