Healthcare Provider Details

I. General information

NPI: 1851358832
Provider Name (Legal Business Name): AREA AGENCY ON AGING OF WESTERN AR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 E 10TH ST
RUSSELLVILLE AR
72801-6027
US

IV. Provider business mailing address

524 GARRISON AVE PO BOX 1724
FORT SMITH AR
72901-2514
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-9618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LISA RUSHING
Title or Position: SUPERVISOR OF CORPORATE SERVICES
Credential:
Phone: 479-783-4500