1720501307 NPI number — A2Z THERAPY OF LITTLE ROCK

Table of content: (NPI 1720501307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720501307 NPI number — A2Z THERAPY OF LITTLE ROCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A2Z THERAPY OF LITTLE ROCK
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:
A2Z THERAPY
Provider Other Organization Name Type Code:
3
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:
1720501307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10702 WARREN DR
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:
72209-8337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-352-9510
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10702 WARREN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-650-3427
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BATTLES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
VERNETTIA
Authorized Official Title or Position:
DIRECTOR OF SOUTH CAROLINA
Authorized Official Telephone Number:
501-650-3427

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 225375742 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP1908 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".