1427612209 NPI number — HAGOOD HOLDINGS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427612209 NPI number — HAGOOD HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAGOOD HOLDINGS, LLC
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:
ALLHEART SENIOR CARE OF ARKANSAS
Provider Other Organization Name Type Code:
3
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:
1427612209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 S STATE ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72201-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-772-6779
Provider Business Mailing Address Fax Number:
888-501-2033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 S STATE ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72201-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-772-6779
Provider Business Practice Location Address Fax Number:
888-501-2033
Provider Enumeration Date:
04/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HAGOOD
Authorized Official First Name:
JARRED
Authorized Official Middle Name:
DEWITT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-529-6543

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 228688765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228687797 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228690732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228686757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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