Healthcare Provider Details

I. General information

NPI: 1952311094
Provider Name (Legal Business Name): STATE OF ARKANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N 7TH ST CRITTENDEN COUNTY HEALTH UNIT
WEST MEMPHIS AR
72301-2001
US

IV. Provider business mailing address

5800 WEST 10TH STREET SUITE 300
LITTLE ROCK AR
72204-1764
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-4334
  • Fax: 870-735-1393
Mailing address:
  • Phone: 501-661-2614
  • Fax: 501-661-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR3983
License Number StateAR

VIII. Authorized Official

Name: MARILYN EVANS
Title or Position: HOME HEALTH ADMINISTRATOR
Credential: RN
Phone: 501-661-2540