=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831628585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABLECARE SUPPORT SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 W CAPITOL AVE STE 1700
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-352-3669
-----------------------------------------------------
Fax | 501-260-7081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1495
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72203-1495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-352-3669
-----------------------------------------------------
Fax | 501-260-7081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | AMANDA STEWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-707-0847
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------