Provider Demographics
NPI:1689657470
Name:ARKANSAS HOSPICE, INC.
Entity type:Organization
Organization Name:ARKANSAS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-748-3333
Mailing Address - Street 1:14 PARKSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7086
Mailing Address - Country:US
Mailing Address - Phone:501-748-3333
Mailing Address - Fax:507-748-3334
Practice Address - Street 1:14 PARKSTONE CIR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7086
Practice Address - Country:US
Practice Address - Phone:501-748-3333
Practice Address - Fax:507-748-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-25
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4195251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135472747Medicaid
AR041564Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER