Provider Demographics
NPI:1942795141
Name:LOAH COMMUNITY DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:LOAH COMMUNITY DEVELOPMENT CENTER
Other - Org Name:LOAH MEDICAL WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-655-4242
Mailing Address - Street 1:110 PONDEROSA LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71909
Mailing Address - Country:US
Mailing Address - Phone:501-655-4242
Mailing Address - Fax:501-922-5660
Practice Address - Street 1:110 PONDEROSA LN
Practice Address - Street 2:SUITE C
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909
Practice Address - Country:US
Practice Address - Phone:501-655-4242
Practice Address - Fax:501-922-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty