1316463730 NPI number — ARKANSAS HOME CARE ASSISTANCE, LLC

Table of content: (NPI 1316463730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316463730 NPI number — ARKANSAS HOME CARE ASSISTANCE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARKANSAS HOME CARE ASSISTANCE, 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:
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:
1316463730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3955 CENTRAL AVE STE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS NATIONAL PARK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-7290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-463-9425
Provider Business Mailing Address Fax Number:
501-463-9426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3955 CENTRAL AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS NATIONAL PARK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-463-9425
Provider Business Practice Location Address Fax Number:
501-463-9426
Provider Enumeration Date:
08/17/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PHILYAW
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
501-463-9425

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , 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: 217707765 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".