1376743641 NPI number — VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.

Table of content: (NPI 1376743641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376743641 NPI number — VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERA LLOYD PRESBYTERIAN FAMILY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VERA LLOYD PRESBYTERIAN HOME & FAMILY SERVICES, INC.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376743641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N. UNIVERSITY AVE., SUITE 345
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72207-5278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-666-8195
Provider Business Mailing Address Fax Number:
501-666-8198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
713 OLD WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71655-9713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-367-9035
Provider Business Practice Location Address Fax Number:
870-367-9038
Provider Enumeration Date:
07/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAHURIN
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
501-666-8195

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  10071 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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