Healthcare Provider Details

I. General information

NPI: 1295790103
Provider Name (Legal Business Name): LITTLE ROCK HOME HEALTH AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11524 N RODNEY PARHAM RD #1
LITTLE ROCK AR
72212-4187
US

IV. Provider business mailing address

2401 S PLUM GROVE RD
PALATINE IL
60067
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-3333
  • Fax: 501-228-0252
Mailing address:
  • Phone: 847-303-5300
  • Fax: 847-303-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberAR4768
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberAR4768
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR4090
License Number StateAR

VIII. Authorized Official

Name: MS. DIANE KUMARICH
Title or Position: NATIONAL CONTRACTS
Credential: RN, MS, MBA
Phone: 847-303-5300