Provider Demographics
NPI:1184634610
Name:ARKANSAS ENTERPRISES FOR THE DEVELOPMENTALLY DISABLED, INC.
Entity Type:Organization
Organization Name:ARKANSAS ENTERPRISES FOR THE DEVELOPMENTALLY DISABLED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-666-0246
Mailing Address - Street 1:105 E ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-2221
Mailing Address - Country:US
Mailing Address - Phone:501-666-0246
Mailing Address - Fax:501-666-2113
Practice Address - Street 1:6 PRODUCTION DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-4357
Practice Address - Country:US
Practice Address - Phone:501-374-7538
Practice Address - Fax:501-666-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR129508774251B00000X
AR112558724251C00000X
AR149854724261Q00000X
AR146646724261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125954767Medicaid
AR129508774Medicaid
AR118199715Medicaid
AR112558724Medicaid
AR5C657OtherAR BLUE CROSS BLUE SHIELD
AR132619786OtherSTATE
AR134433782Medicaid
AR125958775Medicaid
AR146646724Medicaid
AR149854724Medicaid
AR148424715Medicaid