Healthcare Provider Details

I. General information

NPI: 1730257296
Provider Name (Legal Business Name): ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 CROWLEY EUNICE HWY
CROWLEY LA
70526-0888
US

IV. Provider business mailing address

19110 CROWLEY-EUNICE HWY
CROWLEY LA
70526-4124
US

V. Phone/Fax

Practice location:
  • Phone: 337-783-5533
  • Fax: 337-788-1970
Mailing address:
  • Phone: 337-783-5533
  • Fax: 337-788-1970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number941
License Number StateLA

VIII. Authorized Official

Name: BONNIE QUIBODEAUX
Title or Position: CFO
Credential:
Phone: 225-769-7960