Provider Demographics
NPI:1164488318
Name:AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Entity Type:Organization
Organization Name:AREA AGENCY ON AGING OF WESTERN ARKANSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR OF CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-4500
Mailing Address - Street 1:524 GARRISON AVE
Mailing Address - Street 2:PO BOX 1724
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-2514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 S 1ST ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:AR
Practice Address - Zip Code:72855-4453
Practice Address - Country:US
Practice Address - Phone:479-963-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047156Medicare Oscar/Certification