Provider Demographics
NPI:1265833636
Name:ARKANSAS HOME HEALTH PROVIDERS-IV, LLC
Entity Type:Organization
Organization Name:ARKANSAS HOME HEALTH PROVIDERS-IV, LLC
Other - Org Name:ELITE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:3024 RED WOLF BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7415
Practice Address - Country:US
Practice Address - Phone:870-520-6034
Practice Address - Fax:870-520-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR047145Medicare Oscar/Certification
AR205519738Medicaid