Provider Demographics
NPI:1427143551
Name:ARKANSAS HEALTH GROUP
Entity type:Organization
Organization Name:ARKANSAS HEALTH GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-945-0246
Mailing Address - Street 1:3343 SPRINGHILL DR STE 2050
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2946
Mailing Address - Country:US
Mailing Address - Phone:501-945-0246
Mailing Address - Fax:501-945-0216
Practice Address - Street 1:3343 SPRINGHILL DR STE 2050
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2946
Practice Address - Country:US
Practice Address - Phone:501-945-0246
Practice Address - Fax:501-945-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158494002Medicaid
AR5F371Medicare PIN
ARF03575Medicare UPIN
ARDG7544Medicare PIN