MEDICARE: AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC

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	251G00000X	Community Based Hospice Care Agency	0173	AR

General Provider Information

NPI Number	:	1174580252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC

Provider Business Mailing Address
First Line	:	524 GARRISON AVE
Second Line	:	PO BOX 1724
City	:	FORT SMITH
State	:	AR
Zip	:	72901-2514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1579 CLYDE HAWKINS DR
Second Line	:
City	:	WALDRON
State	:	AR
Zip	:	72958-8972
Country	:	US
Telephone Number	:	479-637-4795
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISOR OF CORPORATE SERVICES
Name	:	LISA RUSHING
Credential	:
Telephone Number	:	479-783-4500

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/02/2007

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