Active NPI
State of Arkansas
- Home Health Agency
- Lake Village, AR
National Provider Identifier
1013938893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- AR3977
- Legal business name
- STATE OF ARKANSAS
- Practice address
- 608 Highway 65 82 S
Chicot County Health Unit
Lake Village, AR 71653-1560 - Phone
- (870) 265-2236
- Fax
- (870) 265-5445
- NPI assigned
- Jul 21, 2006
- Organization subpart
- Yes
- Parent organization
- STATE OF ARKANSAS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marilyn Evans, RN
- Title
- Home Health Administrator
- Phone
- (501) 661-2540
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | AR3977 | AR | Primary |
Addresses
Primary practice location
608 Highway 65 82 S
Chicot County Health Unit
Lake Village, AR 71653-1560
Mailing address
5800 West 10TH Street
Suite 300
Little Rock, AR 72204-1764
Phone (501) 661-2614
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 104312514 | Medicaid | AR |
Other names 1
- Chicot County Health Unit
National Provider Directory
National Provider Directory- Part of
- State of Arkansas
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
608 S Highway 65 82
Lake Village, AR 71653
Phone (870) 265-4333
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214956800000",
"number": "1013938893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5800 WEST 10TH STREET",
"address_2": "SUITE 300",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722041764",
"telephone_number": "501-661-2614",
"fax_number": "501-661-2975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 HIGHWAY 65 82 S",
"address_2": "CHICOT COUNTY HEALTH UNIT",
"city": "LAKE VILLAGE",
"state": "AR",
"postal_code": "716531560",
"telephone_number": "870-265-2236",
"fax_number": "870-265-5445"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATE OF ARKANSAS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "STATE OF ARKANSAS",
"enumeration_date": "2006-07-21",
"last_updated": "2008-07-02",
"status": "A",
"authorized_official_last_name": "EVANS",
"authorized_official_first_name": "MARILYN",
"authorized_official_title_or_position": "HOME HEALTH ADMINISTRATOR",
"authorized_official_telephone_number": "501-661-2540",
"authorized_official_credential": "RN"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "AR",
"license": "AR3977",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104312514",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Chicot County Health Unit",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lake Village, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.