Basic Information
| Provider Information | |||||||||
| NPI: | 1205568623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS ADVANCED CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 PARKSTONE CIR | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017483333 | ||||||||
| FaxNumber: | 5017483334 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 PARKSTONE CIR | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017483333 | ||||||||
| FaxNumber: | 5017483334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | KATHERINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP AND CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5017483333 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ARKANSAS HOSPICE, INC. | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 208D00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.