Provider Demographics
NPI:1689751810
Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Entity Type:Organization
Organization Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Other - Org Name:PLEASANT VALLEY LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCMORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-7960
Mailing Address - Street 1:12111 HINSON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3410
Mailing Address - Country:US
Mailing Address - Phone:501-225-8888
Mailing Address - Fax:501-228-7536
Practice Address - Street 1:12111 HINSON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3410
Practice Address - Country:US
Practice Address - Phone:501-225-8888
Practice Address - Fax:501-228-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR695314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR119701311Medicaid
AR04-5390Medicare UPIN