1700120383 NPI number — ABOVE & BEYOND HOME CARE INC

Table of content: (NPI 1700120383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700120383 NPI number — ABOVE & BEYOND HOME CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABOVE & BEYOND HOME CARE 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:
1700120383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 CAMP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCAHONTAS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72455-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-609-1906
Provider Business Mailing Address Fax Number:
870-609-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2379 HIGHWAY 62 412
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72542-9393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-856-3030
Provider Business Practice Location Address Fax Number:
870-856-3033
Provider Enumeration Date:
11/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
870-609-1906

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  AR4821 , 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: 190637757 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 190668752 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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