Healthcare Provider Details

I. General information

NPI: 1114980109
Provider Name (Legal Business Name): AREA AGENCY ON AGING OF NORTHWEST ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 ROCK SPRINGS RD
HARRISON AR
72601-8804
US

IV. Provider business mailing address

PO BOX 1795
HARRISON AR
72602-1795
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-1144
  • Fax: 870-741-1153
Mailing address:
  • Phone: 870-741-1144
  • Fax: 870-741-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG00523
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD B BAILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-741-1144