EVGUENI ROUDACHEVSKI, D.O. (NPI# 1073914719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073914719 |
| Entity Type | Organization |
| Organization Name | EVGUENI ROUDACHEVSKI, D.O. |
| Practice Address |
11912 Kanis Rd Ste F2 Little Rock AR 72211-3771 |
| Practice Telephone | 5012278020 |
| Practice Fax Number | 5012278826 |
| Mailing Telephone | 5012278020 |
| Mailing Fax Number | 5012278826 |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2014-09-12 |
| Authorized Official Name | MRS. HAPSY GLOVER (APN) |
| Authorized Official Telephone | 5012278020 |
| Authorized Official Credential | APN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 314000000X | Skilled Nursing Facility | A03199 | AR | Nursing & Custodial Care Facilities |
| Y | 310400000X | Assisted Living Facility | A03199 | AR | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | NPI | 1568763514 | 01 |
| AR | 186702758 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023569852 | Evgueni Roudachevski, D.o. | Internal Medicine | 11912 Kanis Rd, Suite F2, Little Rock, AR 72211-3733 | 2016-10-17 |
| Street Address |
11912 KANIS RD STE F2 |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72211-3771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265626790 | Izoumroud Osmanovna Soultanova | Family Medicine | 11912 Kanis Rd Ste F2, Little Rock, AR 72211-3771 | 2007-08-28 |
| 1164991048 | Lindsey Irene Bryant | Nurse Practitioner | 11912 Kanis Rd Ste F2, Little Rock, AR 72211-3771 | 2018-11-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004618 | Samantha Lenore Hilborn | Behavior Technician | 1525 Merrill Drive Suite 100, Little Rock, AR 72211 | 2020-05-14 |
| 1003437740 | Centers for Youth and Families, Inc. | Community/Behavioral Health | 1521 Merrill Drive, Suite D220 and E200, Little Rock, AR 72211 | 2020-05-05 |
| 1962040568 | Erica N Taylor | Nurse Practitioner | 11800 Financial Center Parkway, Ste 290, Little Rock, AR 72211 | 2019-12-13 |
| 1568932119 | Katie Jones | Nurse Practitioner | 1children's Way, Little Rock, AR 72211 | 2018-11-27 |
| 1356828651 | Kayleigh King | Dietitian, Registered | 4 Shackleford Plz Ste 209, Little Rock, AR 72211 | 2018-07-19 |
| 1699283838 | Kara Elizabeth Simmons | Physician Assistant | 11215 Hermitage Rd Ste 103, Little Rock, AR 72211 | 2018-01-22 |
| 1194241463 | Wendy Newsam Pllc | Counselor | 1 Innwood Circle, Suite 107, Little Rock, AR 72211 | 2017-08-18 |
| 1861915159 | Sarah Renee Beall | Counselor | 10800 Financial Centre #290, Little Rock, AR 72211 | 2017-07-19 |
| 1457873127 | Restore Hope Counseling Center, Pllc | Counselor | One Innwood Circle, Suite 201, Little Rock, AR 72211 | 2017-07-13 |
| 1447707500 | University of Arkansas for Medical Sciences | Durable Medical Equipment & Medical Supplies | 601 Autumn Road, Little Rock, AR 72211 | 2016-09-07 |
| Find all providers in zip 72211 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679837314 | Little Rock Enrichment Center, Inc. | Assisted Living Facility | 13003 Stacy Ln, Little Rock, AR 72211-3238 | 2012-06-27 |
| 1619116951 | Chenal Heights Retirement Center | Assisted Living Facility | 1 Chenal Heights Dr, Little Rock, AR 72223-3999 | 2009-02-10 |
| 1356798300 | Madison Healthcare and Rehabilitation Center LLC | Assisted Living Facility | 2821 W Dixon Rd, Little Rock, AR 72206-4256 | 2016-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518517127 | Peachtree Village, LLC | Assisted Living Facility | 1500 Fresno St, Fort Smith, AR 72901-7023 | 2019-09-16 |
| 1427539600 | Peachtree Village of Farmington, LLC | Assisted Living Facility | 55 W Rainsong St, Farmington, AR 72730-8635 | 2018-08-24 |
| 1437654670 | Eldercare of Arkansas V, Inc. | Assisted Living Facility | 601 E. Mountain Springs Road, Cabot, AR 72023 | 2018-03-29 |
| 1972007292 | Eldercare of Arkansas IIi, Inc. | Assisted Living Facility | 1306 S. Donaghey, Conway, AR 72034 | 2018-03-21 |
| 1750897039 | Green Acre Easy Lliving | Assisted Living Facility | 2407 W Oak St, Rogers, AR 72758-3943 | 2017-12-21 |
| 1962912626 | Lincolin Co Assisted Living | Assisted Living Facility | 142 Teva Dr, Star City, AR 71667-4253 | 2017-10-09 |
| 1043743768 | Peachtree Village At Holiday Island | Assisted Living Facility | 5 Park Dr, Holiday Island, AR 72631-9388 | 2017-04-10 |
| 1740645456 | Providence PCc of Springdale | Assisted Living Facility | 2175 Orchard St, Springdale, AR 72764-6357 | 2015-12-22 |
| 1649640236 | The Evangelical Lutheran Good Samaritan Society | Assisted Living Facility | 200 Good Samaritan Dr, Mountain Home, AR 72653-9325 | 2015-09-25 |
| 1427444124 | Holiday Island Operations, LLC | Assisted Living Facility | 89 Hillside Drive, Holiday Island, AR 72631 | 2015-04-09 |
| Find all providers with the same taxonomy | ||||
| City | LITTLE ROCK |
| Zip Code | 72211 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.