Provider Demographics
NPI:1235149212
Name:CARE IV, INC.
Entity Type:Organization
Organization Name:CARE IV, INC.
Other - Org Name:CARE IV HOME HEALTH RUSSELLVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-686-2400
Mailing Address - Street 1:1008 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3518
Mailing Address - Country:US
Mailing Address - Phone:479-964-0072
Mailing Address - Fax:479-964-0074
Practice Address - Street 1:1008 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3518
Practice Address - Country:US
Practice Address - Phone:479-964-0072
Practice Address - Fax:479-964-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4325251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159541732Medicaid
AR159585757Medicaid
AR10617OtherBCBS PROVIDER NUMBER
AR155423738Medicaid
AR159584752Medicaid
AR175821514Medicaid
AR175821514Medicaid