Provider Demographics
NPI:1093018723
Name:REVIVE HEARING CENTER OF ARKANSAS
Entity Type:Organization
Organization Name:REVIVE HEARING CENTER OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-360-1143
Mailing Address - Street 1:10700 N RODNEY PARHAM RD STE A7
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-4159
Mailing Address - Country:US
Mailing Address - Phone:501-225-6060
Mailing Address - Fax:501-225-6450
Practice Address - Street 1:10700 N RODNEY PARHAM RD STE A7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4159
Practice Address - Country:US
Practice Address - Phone:501-225-6060
Practice Address - Fax:501-225-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR331237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty