1 Source Senior Care

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

1 SOURCE SENIOR CARE

Practice address

1820 Shelby LN Ste a
Fayetteville, AR 72704-5255

Phone

(479) 443-7173

Fax

(479) 443-0183

NPI assigned

Feb 25, 2020

Last updated

Mar 26, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cathy Robertson

Title

Owner

Phone

(479) 443-7173

Specialties & licenses 4

Addresses

Locations

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1619501087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 SHELBY LN STE A",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045255",
            "telephone_number": "479-443-7173",
            "fax_number": "479-443-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 SHELBY LN STE A",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727045255",
            "telephone_number": "479-443-7173",
            "fax_number": "479-443-0183"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4500 Rogers Ave Ste 3",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729033155",
            "country_code": "US",
            "telephone_number": "479-709-9005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "1 SOURCE SENIOR CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-443-7173"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.