Healthcare Provider Details

I. General information

NPI: 1093063042
Provider Name (Legal Business Name): ARKANSAS HOSPICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PARKSTONE CIR
NORTH LITTLE ROCK AR
72116-7086
US

IV. Provider business mailing address

14 PARKSTONE CIR
NORTH LITTLE ROCK AR
72116-7086
US

V. Phone/Fax

Practice location:
  • Phone: 501-748-3333
  • Fax: 501-748-3334
Mailing address:
  • Phone: 501-748-3333
  • Fax: 501-748-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberE5255
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE6959
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-4668
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC-5585
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-2508
License Number StateAR
# 6
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE1931
License Number StateAR

VIII. Authorized Official

Name: MRS. JUDITH S. WOOTEN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 501-748-3333