Provider Demographics
NPI:1114254406
Name:LEVI HOSPITAL
Entity Type:Organization
Organization Name:LEVI HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:I
Authorized Official - Last Name:VALLEJOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:501-262-1807
Mailing Address - Street 1:300 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-4003
Mailing Address - Country:US
Mailing Address - Phone:501-622-3334
Mailing Address - Fax:
Practice Address - Street 1:130 WERNER ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6443
Practice Address - Country:US
Practice Address - Phone:510-622-3336
Practice Address - Fax:501-623-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT-2534283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital