Provider Demographics
NPI:1639254071
Name:VA DROP-IN CENTER HCMI PROGRAM
Entity Type:Organization
Organization Name:VA DROP-IN CENTER HCMI PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:.SOCIAL WORK ASSOCIATE
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-257-4391
Mailing Address - Street 1:17 WESTFIELD LOOP
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-6950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2003
Practice Address - Country:US
Practice Address - Phone:501-257-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Not Answered286500000XHospitalsMilitary Hospital