Provider Demographics
NPI:1609914464
Name:HOME HEALTH PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:HOME HEALTH PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-932-7630
Mailing Address - Street 1:2222 SPENCE CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7220
Mailing Address - Country:US
Mailing Address - Phone:870-932-7630
Mailing Address - Fax:870-762-2299
Practice Address - Street 1:509 HUTSON ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-2415
Practice Address - Country:US
Practice Address - Phone:870-762-1825
Practice Address - Fax:870-762-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117156514Medicaid
17116OtherBCBS
04-7116Medicare ID - Type Unspecified