MEDICARE: CENTRAL ARKANSAS DISABILITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1144461500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ARKANSAS DISABILITY SERVICES

Provider Business Mailing Address
First Line	:	201 W BROADWAY ST
Second Line	:	SUITE M
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5552
Country	:	US
Telephone Number	:	501-537-1080
Fax Number	:	501-537-1082

Provider Business Practice Location Address
First Line	:	201 W BROADWAY ST
Second Line	:	SUITE M
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5552
Country	:	US
Telephone Number	:	501-537-1080
Fax Number	:	501-537-1082

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. PAMELLA MICHELE CROSS
Credential	:
Telephone Number	:	501-537-1080

Provider Enumeration Date	:	03/16/2009
Last Update Date	:	03/16/2009

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