Basic Information
Provider Information
NPI: 1255314894
EntityType: 2
ReplacementNPI:  
OrganizationName: ARKANSAS HOSPICE, INC.
LastName:  
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MiddleName:  
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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: 2405 E PARKWAY DR
Address2: SUITE 3
City: RUSSELLVILLE
State: AR
PostalCode: 728022274
CountryCode: US
TelephoneNumber: 4794982050
FaxNumber: 4794982053
Other Information
ProviderEnumerationDate: 11/29/2005
LastUpdateDate: 08/01/2013
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: WOOTEN
AuthorizedOfficialFirstName: JUDITH
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: CEO/PRESIDENT
AuthorizedOfficialTelephone: 5017483333
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251G00000XAR4236ARY AgenciesHospice Care, Community Based 

ID Information
IDTypeStateIssuerDescription
15272774705AR MEDICAID


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