Provider Demographics
NPI:1689117756
Name:STATE OF ARKANSAS
Entity Type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:ARKANSAS STATE VETERANS HOME AT NORTH LITTLE ROCK
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHOUA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-683-1862
Mailing Address - Street 1:501 WOODLANE ST STE 401N
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-1133
Mailing Address - Country:US
Mailing Address - Phone:501-683-1862
Mailing Address - Fax:501-682-4833
Practice Address - Street 1:2401 JOHN ASHLEY DRIVE
Practice Address - Street 2:BUILDING #100
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114
Practice Address - Country:US
Practice Address - Phone:501-683-1862
Practice Address - Fax:501-682-0357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-22
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility