Healthcare Provider Details

I. General information

NPI: 1851161061
Provider Name (Legal Business Name): HOLISTIC HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 W 12TH ST
LITTLE ROCK AR
72204-2223
US

IV. Provider business mailing address

3006 W 12TH ST
LITTLE ROCK AR
72204-2223
US

V. Phone/Fax

Practice location:
  • Phone: 501-402-0802
  • Fax: 501-476-0416
Mailing address:
  • Phone: 501-402-0802
  • Fax: 501-476-0416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LYDIA PAGE
Title or Position: MANAGER
Credential:
Phone: 501-409-0802