Healthcare Provider Details

I. General information

NPI: 1407933633
Provider Name (Legal Business Name): ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W MOLINE ST
MALVERN AR
72104-2644
US

IV. Provider business mailing address

1820 W MOLINE ST
MALVERN AR
72104-2644
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-9581
  • Fax: 501-337-9168
Mailing address:
  • Phone: 501-337-9581
  • Fax: 501-337-9168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number734
License Number StateAR

VIII. Authorized Official

Name: MR. DARVIN C. MCMORRIS
Title or Position: AGENT/AUTHORIZED OFFICIAL
Credential:
Phone: 225-769-7960