Basic Information
| Provider Information | |||||||||
| NPI: | 1295790103 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLE ROCK HOME HEALTH AGENCY INC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CARE NETWORK OF LITTLE ROCK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 S PLUM GROVE RD | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473035300 | ||||||||
| FaxNumber: | 8473035376 | ||||||||
| Practice Location | |||||||||
| Address1: | 11524 N RODNEY PARHAM RD | ||||||||
| Address2: | #1 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722124187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012233333 | ||||||||
| FaxNumber: | 5012280252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 04/12/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KUMARICH | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | NATIONAL CONTRACTS | ||||||||
| AuthorizedOfficialTelephone: | 8473035300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | RN, MS, MBA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251J00000X | AR4768 | AR | N | Agencies | Nursing Care | 251F00000X | AR4768 | AR | N | Agencies | Home Infusion | 251E00000X | AR4090 | AR | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 137741738 | 05 | AR | MEDICAID | 138499757 | 05 | AR | MEDICAID | 14192765 | 05 | AR | MEDICAID | 138507750 | 05 | AR | MEDICAID | 137740514 | 05 | AR | MEDICAID | 138506752 | 05 | AR | MEDICAID | 141492765 | 05 | AR | MEDICAID | 139100742 | 05 | AR | MEDICAID | 137742732 | 05 | AR | MEDICAID |