MEDICARE: CARECO HOMECARE AGENCY

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1710679451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARECO HOMECARE AGENCY

Provider Business Mailing Address
First Line	:	6834 CANTRELL RD # 2099
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4135
Country	:	US
Telephone Number	:	501-577-3888
Fax Number	:	501-333-9192

Provider Business Practice Location Address
First Line	:	4700 W COMMERCIAL DR STE B3
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8073
Country	:	US
Telephone Number	:	501-557-3888
Fax Number	:	501-333-9192

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LATOSHA MARTIN
Credential	:
Telephone Number	:	501-557-3888

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	06/20/2023

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