Provider Demographics
NPI:1467906495
Name:ARKANSAS COMPLETE CARE, LLC
Entity Type:Organization
Organization Name:ARKANSAS COMPLETE CARE, LLC
Other - Org Name:COMPLETE PULMONARY REHAB-LR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELL-HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:501-744-0849
Mailing Address - Street 1:2310 HOLLY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-9432
Mailing Address - Country:US
Mailing Address - Phone:501-291-5759
Mailing Address - Fax:501-781-2234
Practice Address - Street 1:3 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3843
Practice Address - Country:US
Practice Address - Phone:501-744-8049
Practice Address - Fax:501-781-2234
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS COMPLETE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-08
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204896742Medicaid
AR204896742Medicaid