MEDICARE: ARROWSTAR LIVING ASSISTANCE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1952964140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARROWSTAR LIVING ASSISTANCE SERVICES

Provider Business Mailing Address
First Line	:	412 N HIGHWAY 65 82
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1661
Country	:	US
Telephone Number	:	870-632-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1659 S HIGHWAY 65 82
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1661
Country	:	US
Telephone Number	:	870-632-7099
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ETHEL FREDRICKSON
Credential	:
Telephone Number	:	870-632-7099

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	10/27/2025

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