Provider Demographics
NPI:1386652428
Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Entity type:Organization
Organization Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AGENT/DESIGNATED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCMORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-7960
Mailing Address - Street 1:101 BROUGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2505
Mailing Address - Country:US
Mailing Address - Phone:870-739-3268
Mailing Address - Fax:870-739-4669
Practice Address - Street 1:101 BROUGHAM AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2505
Practice Address - Country:US
Practice Address - Phone:870-739-3268
Practice Address - Fax:870-739-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR786314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158268311Medicaid
AR04-5412Medicare UPIN