Healthcare Provider Details

I. General information

NPI: 1881224046
Provider Name (Legal Business Name): INDEPENDENCE CARE OF ARKANSAS AT LITTLE ROCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W CAPITOL AVE STE 1228
LITTLE ROCK AR
72201-3405
US

IV. Provider business mailing address

3301 BONITA BEACH RD STE 208
BONITA SPRINGS FL
34134-7835
US

V. Phone/Fax

Practice location:
  • Phone: 774-452-6198
  • Fax: 412-312-3828
Mailing address:
  • Phone: 917-733-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALLISON VIAR
Title or Position: OWNER
Credential:
Phone: 917-733-1135