State of Arkansas

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

AR3629 Issued in AR

Legal business name

STATE OF ARKANSAS

Practice address

404 El Paso
Northwest Regional Office
Russellville, AR 72801-8737

Phone

(501) 661-2698

Fax

(501) 280-4626

NPI assigned

Jul 1, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Gayla Evette Lanum, R.N. BSN

Title

Hospice Director

Phone

(501) 661-2698

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Arkansas Department of Health Hospice 3 Doing business as

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1720017833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 WEST 10TH ST",
            "address_2": "SUITE 300",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041764",
            "telephone_number": "501-661-2698",
            "fax_number": "501-280-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 EL PASO",
            "address_2": "NORTHWEST REGIONAL OFFICE",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728018737",
            "telephone_number": "501-661-2698",
            "fax_number": "501-280-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "LANUM",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_middle_name": "EVETTE",
        "authorized_official_title_or_position": "HOSPICE DIRECTOR",
        "authorized_official_telephone_number": "501-661-2698",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N. BSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AR",
            "license": "AR3629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR STATE HOSPICE LICENSE",
            "identifier": "AR3629",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123489747",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Department of Health Hospice 3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laura Stadler, QBHP
• Kenneth Standridge
• Stormy Elaine Stane, APRN
• Logan Stanton, RECOVERY ASSISTANT
• State of Arkansas
• Randy Paul Stayton
• Lynda Steed, OT
• James Steinbeck
• Stella Manor Care Center Inc
• Stephen M. Killingsworth, MD, PA

• Community Based Hospice Care Agency in Russellville, AR
• Providers in Russellville, AR by specialty
• Community Based Hospice Care Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2012; 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.