Provider Demographics
NPI:1760627640
Name:CAVHS
Entity Type:Organization
Organization Name:CAVHS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERT. RECREATION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:501-257-3469
Mailing Address - Street 1:2220 FT. ROOTS DRIVE 116B NLR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1706
Mailing Address - Country:US
Mailing Address - Phone:501-257-3469
Mailing Address - Fax:
Practice Address - Street 1:2220 FT ROOTS DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1706
Practice Address - Country:US
Practice Address - Phone:501-257-3469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERT. ID # 22745313M00000X
NY22745314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility