Allegiance Specialty Hospital of Little Rock, LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

AR4374 Issued in AR

Legal business name

ALLEGIANCE SPECIALTY HOSPITAL OF LITTLE ROCK, LLC

Practice address

11401 Interstate 30 FL 2
Little Rock, AR 72209-7042

Phone

(501) 455-7300

Fax

(501) 601-1333

NPI assigned

Sep 26, 2006

Last updated

May 1, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Rock Bordelon

Title

Ceo

Phone

(318) 629-5321

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225139637. Details of each certification follow.

• CCN 040148 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 040148

Legal name

ALLEGIANCE SPECIALTY HOSPITAL OF LR LLC

Certification status

Terminated Voluntary: merger or closure, Jun 1, 2007

Provider type (POS)

Hospital – Short-term

Participating since

Nov 29, 2006

Last certification

Nov 29, 2006

Beds

40

Ownership / control type

Private (for profit)

Facility address

11401 Interstate 30, 2ND Floor
Little Rock, AR 72209

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1225139637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 TEXAS ST STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013526",
            "telephone_number": "318-226-2802",
            "fax_number": "318-226-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11401 INTERSTATE 30 FL 2",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722097042",
            "telephone_number": "501-455-7300",
            "fax_number": "501-601-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLEGIANCE SPECIALTY HOSPITAL OF LITTLE ROCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "BORDELON",
        "authorized_official_first_name": "ROCK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-629-5321",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "AR",
            "license": "AR4374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "163089105",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Long Term Care Hospital in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Long Term Care Hospital in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.