Provider Demographics
NPI:1902131881
Name:BAPTIST HEALTH
Entity Type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:BAPTIST HEALTH BEHAVIORAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-1542
Mailing Address - Street 1:9110 KANIS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6418
Mailing Address - Country:US
Mailing Address - Phone:501-202-3991
Mailing Address - Fax:501-202-6340
Practice Address - Street 1:11321 INTERSTATE 30 STE 104
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7064
Practice Address - Country:US
Practice Address - Phone:501-202-7502
Practice Address - Fax:501-202-1357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR040114Medicare Oscar/Certification