Provider Demographics
NPI:1891779930
Name:CENTRAL ARKANSAS AREA AGENCY ON AGING, INC
Entity type:Organization
Organization Name:CENTRAL ARKANSAS AREA AGENCY ON AGING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-688-7483
Mailing Address - Street 1:PO BOX 5988
Mailing Address - Street 2:700 RIVERFRONT DRIVE
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72119-5988
Mailing Address - Country:US
Mailing Address - Phone:501-688-7440
Mailing Address - Fax:501-688-7437
Practice Address - Street 1:706 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5362
Practice Address - Country:US
Practice Address - Phone:501-372-5300
Practice Address - Fax:501-688-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3295251B00000X, 343900000X, 332U00000X, 251E00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120151757Medicaid
AR208117797Medicaid
AR120611765Medicaid
AR120150753Medicaid
AR104703732Medicaid