Basic Information
| Provider Information | |||||||||
| NPI: | 1841770302 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUFFIE HEALTHCARE LLC | ||||||||
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| OtherOrganizationName: | CUFFIE HEALTHCARE SERVICES, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 INGRAM BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723013403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703944600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 403 INGRAM BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703944600 | ||||||||
| FaxNumber: | 8705513724 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | CUFFIE | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8703944600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 251E00000X | AR | N | Agencies | Home Health | 291U00000X | N | Laboratories | Clinical Medical Laboratory | 343900000X | N | Transportation Services | Non-emergency Medical Transport (VAN) | 3747P1801X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant |
ID Information
| ID | Type | State | Issuer | Description | 224967774 | 05 | AR | MEDICAID | 226400736 | 05 | AR | MEDICAID | 224968767 | 05 | AR | MEDICAID | 226400732 | 05 | AR | MEDICAID |