1184634610 NPI number — ARKANSAS ENTERPRISES FOR THE DEVELOPMENTALLY DISABLED, INC.

Table of content: (NPI 1184634610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184634610 NPI number — ARKANSAS ENTERPRISES FOR THE DEVELOPMENTALLY DISABLED, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS ENTERPRISES FOR THE DEVELOPMENTALLY DISABLED, 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:
Provider Other Organization Name Type Code:
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:
1184634610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 E ROOSEVELT RD
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:
72206-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-666-0246
Provider Business Mailing Address Fax Number:
501-666-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 PRODUCTION DR
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:
72209-4357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-374-7538
Provider Business Practice Location Address Fax Number:
501-666-2113
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLDING
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
501-666-0246

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  129508774 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X , with the licence number: 112558724 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X , with the licence number: 149854724 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X , with the licence number: 146646724 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 125954767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129508774 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118199715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112558724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5C657 . This is a "AR BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 132619786 . This is a "STATE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 134433782 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125958775 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146646724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149854724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148424715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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