Provider Demographics
NPI:1093063042
Name:ARKANSAS HOSPICE, INC.
Entity Type:Organization
Organization Name:ARKANSAS HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-748-3333
Mailing Address - Street 1:14 PARKSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7086
Mailing Address - Country:US
Mailing Address - Phone:501-748-3333
Mailing Address - Fax:501-748-3334
Practice Address - Street 1:14 PARKSTONE CIR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7086
Practice Address - Country:US
Practice Address - Phone:501-748-3333
Practice Address - Fax:501-748-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1931207QH0002X
ARE6959207QH0002X
ARE-4668207QH0002X
ARE-2508207QH0002X
ARE5255207RH0002X
ARC-5585207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR00000OtherUPIN