Basic Information
| Provider Information | |||||||||
| NPI: | 1619379484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS HOME HEALTH PROVIDERS-III, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10710 OTTER CREEK EAST BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MABELVALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721035808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014550010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 318 S RHODES ST | ||||||||
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| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706333551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5014550010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | N | Agencies | Nursing Care | 251E00000X | AR5088 | AR | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 205518738 | 05 | AR | MEDICAID |