Provider Demographics
NPI:1780121269
Name:LRCMHC
Entity type:Organization
Organization Name:LRCMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR/CASE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARON
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-9300
Mailing Address - Street 1:1100 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-6343
Mailing Address - Country:US
Mailing Address - Phone:501-686-9300
Mailing Address - Fax:
Practice Address - Street 1:1100 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-6343
Practice Address - Country:US
Practice Address - Phone:501-686-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1104258714Medicaid