Provider Demographics
NPI:1336159318
Name:CARE IV, INC.
Entity type:Organization
Organization Name:CARE IV, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-2400
Mailing Address - Street 1:3801 MAIN DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5297
Mailing Address - Country:US
Mailing Address - Phone:479-750-1155
Mailing Address - Fax:479-750-2228
Practice Address - Street 1:3801 GREATHOUSE SPRINGS ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:JOHNSON
Practice Address - State:AR
Practice Address - Zip Code:72741
Practice Address - Country:US
Practice Address - Phone:479-750-1155
Practice Address - Fax:479-750-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3546251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132078738Medicaid
AR10701OtherBCBS PROVIDER NUMBER
AR2601929OtherUHC NONPAR NUMBER