Provider Demographics
NPI:1346571163
Name:GVAL, LLC
Entity Type:Organization
Organization Name:GVAL, LLC
Other - Org Name:THE GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-224-0846
Mailing Address - Street 1:PO BOX 56678
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6678
Mailing Address - Country:US
Mailing Address - Phone:501-224-0846
Mailing Address - Fax:501-224-0834
Practice Address - Street 1:1625 E 42ND ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1654
Practice Address - Country:US
Practice Address - Phone:870-772-0689
Practice Address - Fax:870-772-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR485311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175999732Medicaid