Healthcare Provider Details

I. General information

NPI: 1447409826
Provider Name (Legal Business Name): ARKANSAS COMMUNITY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 12TH ST STE 300
OAKLAND CA
94607-4087
US

IV. Provider business mailing address

500 12TH ST STE 300
OAKLAND CA
94607-4087
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-0311
  • Fax: 510-817-1894
Mailing address:
  • Phone: 510-832-0311
  • Fax: 510-817-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number14238 (ACC)
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0313
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number12282
License Number StateAR

VIII. Authorized Official

Name: MR. JAMES NOVELLO JR.
Title or Position: SR. V.P. AND GENERAL COUNSEL
Credential:
Phone: 510-817-1845