MEDICARE: ARKANSAS HOME HEALTH PROVIDERS-IV, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174925945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS HOME HEALTH PROVIDERS-IV, LLC

Provider Business Mailing Address
First Line	:	10710 OTTER CREEK EAST BLVD
Second Line	:	SUITE 400
City	:	MABELVALE
State	:	AR
Zip	:	72103-5808
Country	:	US
Telephone Number	:	501-455-0010
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 NATHAN ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-1447
Country	:	US
Telephone Number	:	870-358-4018
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RICHARD A WILLIAMS
Credential	:
Telephone Number	:	501-455-0010

Provider Enumeration Date	:	09/23/2014
Last Update Date	:	09/23/2014

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