MEDICARE: SUPPORT SOLUTIONS OF ARKANSAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780999193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPORT SOLUTIONS OF ARKANSAS

Provider Business Mailing Address
First Line	:	818 CANAL ST
Second Line	:
City	:	MARION
State	:	AR
Zip	:	72364-5075
Country	:	US
Telephone Number	:	901-383-9193
Fax Number	:	901-383-9195

Provider Business Practice Location Address
First Line	:	5909 SHELBY OAKS DR STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-383-9193
Fax Number	:	901-383-9195

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. LARRY L. DURBIN
Credential	:	ED. D.
Telephone Number	:	901-383-9193

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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