NPIMap

Organization Active NPI

State of Arkansas

  • Skilled Nursing Facility
  • North Little Rock, AR
National Provider Identifier
1689117756
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STATE OF ARKANSAS
Practice address
2401 John Ashley Drive
Building #100
North Little Rock, AR 72114
Phone
(501) 683-1862
Fax
(501) 682-0357
NPI assigned
Nov 22, 2016
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
STATE OF ARKANSASAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Ms. Phoua Lee
Title
Finance Manager
Phone
(501) 683-1862

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

2401 John Ashley Drive
Building #100
North Little Rock, AR 72114

Mailing address

501 Woodlane St Ste 401N
Little Rock, AR 72201-1133
Phone (501) 683-1862

Other names 1

  • Arkansas State Veterans Home at North Little Rock Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170508000583 AR Part A Provider - Skilled Nursing Facility 6507863958 Practice locations: North Little Rock, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689117756. Details of each certification follow.

Skilled nursing facility certification: CCN 045462

Legal name
STATE OF ARKANSAS
Doing business as
ARKANSAS STATE VETERANS HOME AT NORTH LITTLE ROCK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 27, 2017
Last certification
May 1, 2025
Beds
96
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
2401 John Ashley Drive
Community Center Building 100
North Little Rock, AR 72114-1825
Nursing home name
ARKANSAS STATE VETERANS HOME AT NORTH LITTLE ROCK

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Arkansas State Veterans Home at North Little RockCCN 045462 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Government - State
Certified
Apr 27, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9687.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2127171Arkansas State Veterans Home2401 John Ashley Drive, NLR, AR 72114Certificate of waiverMar 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
State of Arkansas14 organizations share this tax ID, including this one
Part of
State of Arkansas

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations (25 of 58)

724 Ash Flat Dr
Ash Flat, AR 72513
Phone (870) 994-2816

150 Keller St
Ashdown, AR 71822
Phone (870) 898-3141

120 Weaver Ave
Batesville, AR 72501
Phone (870) 793-8852

1612 Edison Ave
Benton, AR 72015
Phone (501) 303-5650

402 Hailey Rd
Berryville, AR 72616
Phone (870) 423-2506

1299 N 10th St
Blytheville, AR 72315
Phone (870) 763-7064

409 W 4th St
Brinkley, AR 72021
Phone (870) 527-2186

740 California Ave SW
Camden, AR 71701
Phone (870) 836-7395

1129 S Rogers St
Clarksville, AR 72830
Phone (479) 754-3002

1219 S Rogers St
Clarksville, AR 72830
Phone (479) 754-3002

22 S Sherwood Plz
Clarksville, AR 72830
Phone (479) 754-2949

1101 Museum Rd
Ste 7
Conway, AR 72032
Phone (501) 358-6535

117 Pine St
Crossett, AR 71635
Phone (870) 364-4035

1300 W 5th Ave
Crossett, AR 71635
Phone (870) 364-2115

719 N 5th St
Dardanelle, AR 72834
Phone (479) 229-1496

204 Main St
Des Arc, AR 72040
Phone (870) 256-3065

751 Highway 65 S
Dumas, AR 71639
Phone (870) 382-2377

301 American Rd
El Dorado, AR 71730
Phone (870) 863-3351

413 N Division St
Forrest City, AR 72335
Phone (870) 633-1340

401 N Cherry St
Hamburg, AR 71646
Phone (870) 853-5525

2319 Highway 110 W
Ste C
Heber Springs, AR 72543
Phone (501) 362-4602

506 W Court St
Jasper, AR 72641
Phone (870) 446-2286

611 E Washington Ave
Jonesboro, AR 72401
Phone (870) 933-8734

1113 Chestnut St
Lewisville, AR 71845
Phone (870) 921-4509

3600 Cantrell Rd
Ste 203
Little Rock, AR 72202
Phone (501) 280-3234

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Phoua Lee Individual Corporate OfficerAccounting Operations Manager Nov 20, 2017 100%
W-2 Managing EmployeeAccounting Operations Manager Nov 20, 2017 100%
State of Arkansas Organization, Little Rock, AR Other Jan 17, 2017 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
State of ArkansasLittle Rock, AR, CCN 044011 Hospital Operational/Managerial Control Apr 13, 2022
Arkansas Veterans Home at FayettevilleFayetteville, AR, CCN 045417 Skilled nursing facility 5% Or Greater Direct Ownership Interest Jul 1, 2006

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • State of Arkansas

    dba Arkansas State Hospital

    • Psychiatric Hospital
    • Little Rock, AR
    • NPI 1295726156

    Operational/Managerial Control

    CMS ownership
  • State of Arkansas

    dba Arkansas Veterans Home at Fayetteville

    • Skilled Nursing Facility
    • Fayetteville, AR
    • NPI 1417052895

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 50

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1479772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1689117756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 WOODLANE ST STE 401N",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722011133",
            "telephone_number": "501-683-1862",
            "fax_number": "501-682-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 JOHN ASHLEY DRIVE",
            "address_2": "BUILDING #100",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72114",
            "telephone_number": "501-683-1862",
            "fax_number": "501-682-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARKANSAS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF ARKANSAS",
        "enumeration_date": "2016-11-22",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "PHOUA",
        "authorized_official_title_or_position": "FINANCE MANAGER",
        "authorized_official_telephone_number": "501-683-1862",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas State Veterans Home at North Little Rock",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Arkansas State Veterans Home at North Little Rock",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in North Little Rock, AR

Sources for this page

Verify at the official NPI Registry.