Provider Demographics
NPI:1366082521
Name:ATERA HOME CARE
Entity type:Organization
Organization Name:ATERA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MARKETING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-350-0550
Mailing Address - Street 1:3803 SW SANDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8646
Mailing Address - Country:US
Mailing Address - Phone:479-350-0550
Mailing Address - Fax:
Practice Address - Street 1:3803 SW SANDSTONE AVE
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-8646
Practice Address - Country:US
Practice Address - Phone:479-350-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236664732Medicaid