Provider Demographics
NPI:1154342947
Name:STATE OF ARKANSAS
Entity type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-661-2540
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:SLOT H-49 ARKANSAS DEPT OF HEALTH AND HUMAN SERVICES
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-1437
Mailing Address - Country:US
Mailing Address - Phone:501-661-2614
Mailing Address - Fax:501-661-2975
Practice Address - Street 1:1616 S MADISON ST
Practice Address - Street 2:ARKANSAS COUNTY HEALTH UNIT
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3003
Practice Address - Country:US
Practice Address - Phone:870-946-2662
Practice Address - Fax:870-946-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4040251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047883Medicare ID - Type Unspecified