Healthcare Provider Details

I. General information

NPI: 1265833636
Provider Name (Legal Business Name): ARKANSAS HOME HEALTH PROVIDERS-IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 RED WOLF BLVD SUITE 6
JONESBORO AR
72401-7415
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 870-520-6034
  • Fax: 870-520-6279
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA L. PROFFITT
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307