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General NPI Number Information
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NPI Number | 1750096566
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Entity Type | Organization
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Legal Business Name | THE BLAKE AT CHENAL VALLEY LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 2101 RAHLING RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223-6126
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Country | US
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Telephone | 501-710-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 RAHLING RD
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City | LITTLE ROCK
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State | AR
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Zip | 72223-6126
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Country | US
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Telephone | 662-419-8552
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | STEPHEN BLACK
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Credential |
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Telephone | 501-710-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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