Provider Demographics
NPI:1346630589
Name:CHG HOSPITAL LITTLE ROCK, LLC
Entity type:Organization
Organization Name:CHG HOSPITAL LITTLE ROCK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR, LICENSURE AND CERTIFICATION
Authorized Official - Prefix:
Authorized Official - First Name:JOHNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-6063
Mailing Address - Street 1:680 SOUTH FOURTH STREET
Mailing Address - Street 2:LICENSE AND CERTIFICATION
Mailing Address - City:LOUSIVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2708
Mailing Address - Country:US
Mailing Address - Phone:025-966-0635
Mailing Address - Fax:502-212-8481
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:6TH FLOOR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-265-0600
Practice Address - Fax:501-265-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR213284105Medicaid
AR042010Medicare Oscar/Certification