1336159318 NPI number — CARE IV, INC.

Table of content: (NPI 1336159318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336159318 NPI number — CARE IV, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE IV, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARE IV HOME HEALTH SPRINGDALE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336159318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 MAIN DR
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72704-5297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-750-1155
Provider Business Mailing Address Fax Number:
479-750-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 GREATHOUSE SPRINGS ROAD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-750-1155
Provider Business Practice Location Address Fax Number:
479-750-2228
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMMOND
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/GENERAL MANAGER
Authorized Official Telephone Number:
501-686-2400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  AR3546 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132078738 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10701 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 2601929 . This is a "UHC NONPAR NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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