Healthcare Provider Details

I. General information

NPI: 1912963075
Provider Name (Legal Business Name): AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 7TH ST
MENA AR
71953-3205
US

IV. Provider business mailing address

3600 WHEELER AVE STE 2
FORT SMITH AR
72901-6621
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-5458
  • Fax:
Mailing address:
  • Phone: 479-783-4500
  • Fax: 855-515-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4077
License Number StateAR

VIII. Authorized Official

Name: DANA CALLAWAY
Title or Position: CFO
Credential:
Phone: 479-424-2020