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General NPI Number Information
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NPI Number | 1407933633
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Entity Type | Organization
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Legal Business Name | ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 1820 W MOLINE ST
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City | MALVERN
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State | AR
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Zip | 72104-2644
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Country | US
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Telephone | 501-337-9581
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Fax | 501-337-9168
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Provider Business Mailing Address
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Address Line | 1820 W MOLINE ST
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City | MALVERN
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State | AR
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Zip | 72104-2644
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Country | US
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Telephone | 501-337-9581
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Fax | 501-337-9168
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Authorized Official
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Title or Position | AGENT/AUTHORIZED OFFICIAL
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Name | MR. DARVIN C. MCMORRIS
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Credential |
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Telephone | 225-769-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 734
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License Number State | AR
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