NPIMap

Organization Active NPI

State of Arkansas

  • Community Based Hospice Care Agency
  • Forrest City, AR
National Provider Identifier
1962430744
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0137 Issued in AR
Legal business name
STATE OF ARKANSAS
Practice address
1501 Dawson Rd
Forrest City, AR 72335-2088
Phone
(501) 661-2698
Fax
(501) 280-4626
NPI assigned
Jun 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Authorized official

Name
Ms. Gayla Lanum, R.N.
Title
Hospice Director
Phone
(501) 661-2698

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0137 AR Primary

Addresses

Primary practice location

1501 Dawson Rd
Forrest City, AR 72335-2088

Mailing address

5800 W 10TH St
Suite 300
Little Rock, AR 72204-1752
Phone (501) 661-2698

Other identifiers 2

IdentifierTypeStateIssuer
0137OtherARAR STATE HOSPICE LICENSE
123489747MedicaidAR

Other names 1

  • Arkansas Department of Health Hospice 9E Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1962430744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 W 10TH ST",
            "address_2": "SUITE 300",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722041752",
            "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": "1501 DAWSON RD",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723352088",
            "telephone_number": "501-661-2698",
            "fax_number": "501-280-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF ARKANSAS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "LANUM",
        "authorized_official_first_name": "GAYLA",
        "authorized_official_title_or_position": "HOSPICE DIRECTOR",
        "authorized_official_telephone_number": "501-661-2698",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AR",
            "license": "0137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AR STATE HOSPICE LICENSE",
            "identifier": "0137",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123489747",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arkansas Department of Health Hospice 9E",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forrest City, AR

Sources for this page

  • 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.