Provider Demographics
NPI:1386311694
Name:HOGAN, CASSANDRA S
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:S
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 CENTRAL AVE STE 402E
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5350
Mailing Address - Country:US
Mailing Address - Phone:501-318-4382
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE STE 402E
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5350
Practice Address - Country:US
Practice Address - Phone:501-318-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR5725372500000X, 372600000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR265345797Medicaid
AR266067757Medicaid
AR265343732Medicaid