Provider Demographics
NPI:1427612209
Name:HAGOOD HOLDINGS, LLC
Entity type:Organization
Organization Name:HAGOOD HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARRED
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:HAGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-529-6543
Mailing Address - Street 1:322 S STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-2116
Mailing Address - Country:US
Mailing Address - Phone:501-772-6779
Mailing Address - Fax:888-501-2033
Practice Address - Street 1:322 S STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-2116
Practice Address - Country:US
Practice Address - Phone:501-772-6779
Practice Address - Fax:888-501-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228688765Medicaid
AR228687797Medicaid
AR228690732Medicaid
AR228686757Medicaid