Irene Mack

Key facts

NPI

1497038699

Entity type

Individual (NPI type 1)

Primary specialty

Homemaker 376J00000X

License

253Z00000X (AR)

Practice address

225 N 5TH St
West Memphis, AR 72301-3212

Phone

(870) 735-2007

Fax

(870) 735-2025

NPI assigned

Sep 23, 2011

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goldens Adult Daycare, LLC Home Health Agency · Helena, AR · NPI 1316222128
  NPD Authorized official
• Golden 1 In Home Supportive Care Agency · Memphis, TN · NPI 1003234618
  NPD (past) Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 3, 2025.

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1497038699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 N 5TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013212",
            "telephone_number": "870-735-2007",
            "fax_number": "870-735-2025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N 5TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723013212",
            "telephone_number": "870-735-2007",
            "fax_number": "870-735-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "IRENE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-23",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "AR",
            "license": "253Z00000X",
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "H445614",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184245732",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in West Memphis, AR · Homemaker in Arkansas