Provider Demographics
NPI:1689654337
Name:AREA AGENCY ON AGING OF SOUTHEAST ARKANSAS INC
Entity Type:Organization
Organization Name:AREA AGENCY ON AGING OF SOUTHEAST ARKANSAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-543-6300
Mailing Address - Street 1:PO BOX 8569
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71611-8569
Mailing Address - Country:US
Mailing Address - Phone:870-543-6300
Mailing Address - Fax:870-534-2152
Practice Address - Street 1:709 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5010
Practice Address - Country:US
Practice Address - Phone:870-543-6300
Practice Address - Fax:870-534-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR103043514Medicaid
AR120723765Medicaid
AR128091738Medicaid
AR120446752Medicaid
AR120448757Medicaid
AR102989732Medicaid
AR146247754Medicaid
AR132845715Medicaid
AR120447753Medicaid
AR17030OtherBLUE CROSS BLUE SHIELD
047308Medicare ID - Type UnspecifiedASHLEY COUNTY
AR120723765Medicaid
AR120447753Medicaid
AR102989732Medicaid
047315Medicare ID - Type UnspecifiedARKANSAS COUNTY
AR120448757Medicaid
047313Medicare ID - Type UnspecifiedGRANT COUNTY
047310Medicare ID - Type UnspecifiedLINCOLN COUNTY
047314Medicare ID - Type UnspecifiedBRADLEY COUNTY