1679963243 NPI number — HIGHLANDS OF LITTLE ROCK RILEY, LLC

Table of content: MR. ROSS ADAM HAUGHN ATC (NPI 1982859500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679963243 NPI number — HIGHLANDS OF LITTLE ROCK RILEY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLANDS OF LITTLE ROCK RILEY, LLC
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:
HIGHLANDS OF LITTLE ROCK AT WOODLAND HILLS THERAPY AND LIVING CENTER
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:
1679963243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8701 RILEY 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:
72205-6509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-224-2700
Provider Business Mailing Address Fax Number:
501-907-0629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8701 RILEY 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:
72205-6509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-224-2700
Provider Business Practice Location Address Fax Number:
501-907-0629
Provider Enumeration Date:
02/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BRINT
Authorized Official First Name:
BLAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
205-410-8371

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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