Area Agency on Aging of Southeast Arkansas Inc

Key facts

NPI: 1689654337
Entity type: Organization (NPI type 2)
Primary specialty: Home Health Agency 251E00000X
Legal business name: AREA AGENCY ON AGING OF SOUTHEAST ARKANSAS INC
Practice address: 709 E 8TH Ave
Pine Bluff, AR 71601-5010
Phone: (870) 543-6300
Fax: (870) 534-2152
NPI assigned: Jan 19, 2006
Organization subpart: No

Authorized official

Name: Mrs. Kathy C Tynes
Title: Executive Director
Phone: (870) 543-6300

Affiliated clinicians 1

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

Paul F Whipple, DO Family Medicine Physician · Star City, AR · NPI 1447335708

Care Compare affiliation Home health agency

Medicare Care Compare: Home health agency

Listed as: Area Agency on Aging of SE Ar Inc CCN 047030
Ownership: Non-Profit
Certified: Jan 5, 1982
Services: Nursing, Home health aide, Physical therapy

Source: Medicare Care Compare.

Medicare Care Compare: Home health agency

Listed as: Aaa Southeast Ar Drew Co CCN 047306
Ownership: Non-Profit
Certified: Jan 7, 1982
Services: Nursing, Home health aide, Physical therapy

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment: Enrolled (2 enrollments) in AR

Home health agency certification: CCN 047030

Legal name: AREA AGENCY ON AGING OF SOUTHEAST ARKANSAS, INC
Certification status: Active
Provider type (POS): Home health agency
Participating since: Jan 5, 1982
Last certification: Dec 6, 2018
Ownership / control type: Non-Profit
Organization structure: Corporation · Non-profit
Incorporated: Jun 15, 1979 in AR
Enrollment address: 709 E 8TH Ave
Pine Bluff, AR 71601-5010
HHA Branch

Home health agency certification: CCN 047306

Legal name: AREA AGENCY ON AGING OF SOUTHEAST ARKANSAS, INC
Certification status: Active
Provider type (POS): Home health agency
Participating since: Jan 7, 1982
Last certification: Oct 18, 2018
Ownership / control type: Non-Profit
Organization structure: Corporation · Non-profit
Incorporated: Jun 15, 1979 in AR
Enrollment address: 110 E Gaines St
Monticello, AR 71655-4902
HHA Branch

All disclosed owners & managing parties 5

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

Name	Role	Since	Share
Melody Berry Individual	W-2 Managing Employee	Jun 30, 2007
Kathy Tynes Individual	W-2 Managing Employee Director of Fiscal Operations	Feb 16, 2018	100%
	Corporate Director	Dec 23, 2018
	W-2 Managing Employee Director of Fiscal Operations	Feb 16, 2018
James Word Individual	Corporate Director Executive Director	Feb 16, 2018	100%
James Word Individual	W-2 Managing Employee	Feb 16, 2018
Area Agency on Aging of Southeast Arkansas, Inc Organization · Pine Bluff, AR Non-profit	5% Or Greater Direct Ownership Interest	Sep 26, 2008
Betty Bradshaw Individual	Corporate Director	Sep 26, 2008

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20081114000561	AR	Part a Provider - Home Health Agency	8820023468	Practice locations: Pine Bluff, AR
O20081211000106	AR	Part a Provider - Home Health Agency	8820023468	Practice locations: Monticello, AR

National Provider Directory

Locations

208 N Alabama St
Crossett, AR 71635
Phone (870) 364-7788

310 Main St
Lake Village, AR 71653
Phone (870) 265-3841

114 N Chicot St
Lake Village, AR 71653
Phone (870) 265-3841

929 Lakeside St
Lake Village, AR 71653
Phone (870) 265-3841

110 E Gaines St
Monticello, AR 71655
Phone (870) 367-9873

709 E 8th Ave
Pine Bluff, AR 71601
Phone (870) 543-6300

200 E 11th Ave
Ste K
Pine Bluff, AR 71601
Phone (870) 543-6300

811 E Center St
Ste A
Sheridan, AR 72150
Phone (870) 942-4842

700 S Lincoln Ave
Star City, AR 71667
Phone (870) 628-5147

711 S Lincoln Ave
Star City, AR 71667
Phone (870) 619-4514

2116 S Buerkle St
Ste A
Stuttgart, AR 72160
Phone (870) 673-7146

807 N Main St
Stuttgart, AR 72160
Phone (870) 673-7146

96 N Etheridge St
Warren, AR 71671
Phone (870) 226-5769

1105 E Church St
Warren, AR 71671
Phone (870) 226-5769

110 E Cedar St
Warren, AR 71671
Phone (870) 226-5769

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Home Health Agency	251E00000X			Yes

Addresses

Primary practice location

709 E 8TH Ave
Pine Bluff, AR 71601-5010

Mailing address

PO Box 8569
Pine Bluff, AR 71611-8569
Phone (870) 543-6300

Other identifiers

Identifier	Type	State	Issuer
103043514	Medicaid	AR
120723765	Medicaid	AR
128091738	Medicaid	AR
120446752	Medicaid	AR
120448757	Medicaid	AR
102989732	Medicaid	AR
146247754	Medicaid	AR
132845715	Medicaid	AR
120447753	Medicaid	AR
17030	Other	AR	BLUE CROSS BLUE SHIELD

Electronic endpoints

Type	Endpoint	Use	Affiliation
Direct Messaging Address	tmatthews@aaasea.org	Direct

Other providers in Pine Bluff, AR

All providers in Pine Bluff, AR · Home Health Agency in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2019. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.