Basic Information
Provider Information
NPI: 1538112412
EntityType: 2
ReplacementNPI:  
OrganizationName: LIVING HOPE MEDICAL SERVICES LLC
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Mailing Information
Address1: 600 S MCKINLEY ST
Address2: SUITE 400
City: LITTLE ROCK
State: AR
PostalCode: 722055202
CountryCode: US
TelephoneNumber: 5016634673
FaxNumber: 5018011816
Practice Location
Address1: 600 S MCKINLEY ST
Address2: SUITE 400
City: LITTLE ROCK
State: AR
PostalCode: 722055202
CountryCode: US
TelephoneNumber: 5016634673
FaxNumber: 5018011816
Other Information
ProviderEnumerationDate: 05/19/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: STEPHENS
AuthorizedOfficialFirstName: WANDA
AuthorizedOfficialMiddleName: J.
AuthorizedOfficialTitleorPosition: OWNER,PRESIDENT
AuthorizedOfficialTelephone: 5016634673
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X  X193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
283Q00000XAR4301ARX HospitalsPsychiatric Hospital 

No ID Information.


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