Healthcare Provider Details

I. General information

NPI: 1508823113
Provider Name (Legal Business Name): AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S DIVISION ST
LAVACA AR
72941-4126
US

IV. Provider business mailing address

524 GARRISON AVE PO BOX 1724
FORT SMITH AR
72901-2514
US

V. Phone/Fax

Practice location:
  • Phone: 479-674-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4075
License Number StateAR

VIII. Authorized Official

Name: LISA RUSHING
Title or Position: SUPERVISOR OF CORPORATE SERVICES
Credential:
Phone: 479-783-4500