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NPI Code Detail

MEDICARE: LITTLE ROCK COMMUNITY MENTAL HEALTH CENTER, INC.

MEDICARE: LITTLE ROCK COMMUNITY MENTAL HEALTH CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1073685459
Entity Type Code : Organization
Provider Name (Legal Business Name) : LITTLE ROCK COMMUNITY MENTAL HEALTH CENTER, INC.
Provider Business Mailing Address
First Line : 4400 SHUFFIELD DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7100
Country : US
Telephone Number : 501-686-9300
Fax Number : 501-686-9618
Provider Business Practice Location Address
First Line : 4400 SHUFFIELD DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72205-7100
Country : US
Telephone Number : 501-686-9300
Fax Number : 501-686-9618
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. THOMAS A. GRUNDEN
Credential :
Telephone Number : 501-686-9300
Provider Enumeration Date : 11/14/2006
Last Update Date : 08/22/2020

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Practice Location Address:
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Practice Fax:
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1639258635 — MRS. GLENDA BEAUMONT LCSW
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1285706382 — MS. NANCY JANE HAMLIN LCSW
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1336216894 — MS. CARLA DYAN OWENS RN
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