Provider Demographics
NPI:1376743641
Name:VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.
Other - Org Name:VERA LLOYD PRESBYTERIAN HOME & FAMILY SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHURIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-666-8195
Mailing Address - Street 1:1501 N. UNIVERSITY AVE., SUITE 345
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5278
Mailing Address - Country:US
Mailing Address - Phone:501-666-8195
Mailing Address - Fax:501-666-8198
Practice Address - Street 1:713 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9713
Practice Address - Country:US
Practice Address - Phone:870-367-9035
Practice Address - Fax:870-367-9038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10071251S00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities