Provider Demographics
NPI:1316463730
Name:ARKANSAS HOME CARE ASSISTANCE, LLC
Entity type:Organization
Organization Name:ARKANSAS HOME CARE ASSISTANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PHILYAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-463-9425
Mailing Address - Street 1:3955 CENTRAL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7290
Mailing Address - Country:US
Mailing Address - Phone:501-463-9425
Mailing Address - Fax:501-463-9426
Practice Address - Street 1:3955 CENTRAL AVE STE 4
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-463-9425
Practice Address - Fax:501-463-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR217707765Medicaid