Provider Demographics
NPI:1053509125
Name:CENTRAL ARKANSAS THERAPY, LLC
Entity Type:Organization
Organization Name:CENTRAL ARKANSAS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:WILCOX
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:501-837-0028
Mailing Address - Street 1:65 RIVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-1525
Mailing Address - Country:US
Mailing Address - Phone:501-837-0028
Mailing Address - Fax:
Practice Address - Street 1:65 RIVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-1525
Practice Address - Country:US
Practice Address - Phone:501-837-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-13
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1275251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133609721Medicaid
AR146141742Medicaid