Provider Demographics
NPI:1225833411
Name:DEDRA JAI HUE LLC
Entity type:Organization
Organization Name:DEDRA JAI HUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADEIDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:NRCMA, NRCPT
Authorized Official - Phone:501-492-6797
Mailing Address - Street 1:10515 W MARKHAM ST STE I3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2283
Mailing Address - Country:US
Mailing Address - Phone:501-492-6797
Mailing Address - Fax:501-307-1259
Practice Address - Street 1:10515 W MARKHAM ST STE I3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2283
Practice Address - Country:US
Practice Address - Phone:501-492-6797
Practice Address - Fax:501-307-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center