NPIMap

Organization Active NPI

Area Agency on Aging of Western Arkansas, Inc

  • Home Health Agency
  • Greenwood, AR
National Provider Identifier
1609832765
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
4075 Issued in AR
Legal business name
AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Practice address
42 Town SQ
Greenwood, AR 72936-3200
Phone
(479) 996-7040
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lisa Rushing
Title
Supervisor of Corporate Services
Phone
(479) 783-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 4075 AR Primary

Addresses

Primary practice location

42 Town SQ
Greenwood, AR 72936-3200

Mailing address

524 Garrison Ave
PO Box 1724
Fort Smith, AR 72901-2514

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070914000519 AR Part A Provider - Home Health Agency 5991707127 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Smith, AR

Home health agency certification: CCN 047034

Legal name
AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 19, 1982
Last certification
Jun 1, 2021
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Jun 23, 1977 in AR
Enrollment address
3600 Wheeler Ave
Ste 2
Fort Smith, AR 72901-6621

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Area Agency on Aging of Western Arkansas, Inc.CCN 047034
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Jan 19, 1982
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Physical therapy

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jim Petty Individual Corporate DirectorBoard Member Oct 22, 2020
Ricky R Green Individual Corporate DirectorBoard Member Jul 25, 2019
Candice Settle Individual Corporate DirectorBoard Member Feb 25, 2021
Robert Herrera Individual Corporate DirectorBoard Member Apr 27, 2017
Jake Sibley Individual Corporate Officer2ND Vice Chairperson Jan 28, 2021
Jennifer Hallum Individual Corporate OfficerCeo/President Sep 3, 2015
W-2 Managing EmployeeCeo Sep 3, 2015
Phillip Merry Individual Corporate Officer1St Vice Chairperson/Sec-Treasurer Jan 28, 2021
Area Agency on Aging of Western Arkansas, Inc Organization, Fort Smith, AR Created for acquisition, Non-profit 5% Or Greater Direct Ownership Interest Jun 20, 1979 100%
Sharon Brooks Individual Corporate DirectorBoard Member Feb 23, 2011
Dana Callaway Individual Corporate OfficerChief Financial Officer Jun 22, 2016
W-2 Managing EmployeeChief Financial Officer Jun 22, 2016
Doug Kinslow Individual Corporate DirectorBoard Member Apr 27, 2017
T.R. McNutt Individual Corporate OfficerChairman of the Board Jan 28, 2021

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1609832765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 GARRISON AVE",
            "address_2": "PO BOX 1724",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729012514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 TOWN SQ",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729363200",
            "telephone_number": "479-996-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "RUSHING",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "SUPERVISOR OF CORPORATE SERVICES",
        "authorized_official_telephone_number": "479-783-4500"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "AR",
            "license": "4075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, AR

Sources for this page

Verify at the official NPI Registry.