Healthcare Provider Details

I. General information

NPI: 1740368174
Provider Name (Legal Business Name): ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33904 HIGHWAY 63
MARKED TREE AR
72365
US

IV. Provider business mailing address

33904 HIGHWAY 63
MARKED TREE AR
72365
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-2432
  • Fax: 870-358-4582
Mailing address:
  • Phone: 870-358-2432
  • Fax: 870-358-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number736
License Number StateAR

VIII. Authorized Official

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