Provider Demographics
NPI:1447409826
Name:ARKANSAS COMMUNITY CARE, INC.
Entity Type:Organization
Organization Name:ARKANSAS COMMUNITY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. V.P. AND GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVELLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:510-817-1845
Mailing Address - Street 1:500 12TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4087
Mailing Address - Country:US
Mailing Address - Phone:510-832-0311
Mailing Address - Fax:510-817-1894
Practice Address - Street 1:500 12TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4087
Practice Address - Country:US
Practice Address - Phone:510-832-0311
Practice Address - Fax:510-817-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12282302R00000X
TX14238 (ACC)302R00000X
OK0313302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0313OtherMEDICARE ADVANTAGE
AR12282OtherMEDICARE ADVANTAGE
TX14238 (ACC)OtherMEDICARE ADVANTAGE