Healthcare Provider Details

I. General information

NPI: 1174356497
Provider Name (Legal Business Name): CARECONNECT. ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 LORIAN DR
LITTLE ROCK AR
72212-2660
US

IV. Provider business mailing address

6834 CANTRELL RD
LITTLE ROCK AR
72207-4135
US

V. Phone/Fax

Practice location:
  • Phone: 501-468-0779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DEIRDRE SHEAD
Title or Position: DIRECTOR
Credential:
Phone: 314-600-1005