Provider Demographics
NPI:1184792830
Name:THE ACADEMY AT RIVERDALE
Entity type:Organization
Organization Name:THE ACADEMY AT RIVERDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-6965
Mailing Address - Street 1:1600 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1704
Mailing Address - Country:US
Mailing Address - Phone:501-663-6965
Mailing Address - Fax:501-603-0675
Practice Address - Street 1:1600 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-1704
Practice Address - Country:US
Practice Address - Phone:501-663-6965
Practice Address - Fax:501-603-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty