Provider Demographics
NPI:1821295346
Name:UAMS HEALTH COMPREHENSIVE CARE AT HOME, LLC
Entity Type:Organization
Organization Name:UAMS HEALTH COMPREHENSIVE CARE AT HOME, LLC
Other - Org Name:UAMS HEALTH-HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP TAX
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGLICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-299-3803
Mailing Address - Street 1:3854 AMERICAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4013
Mailing Address - Country:US
Mailing Address - Phone:225-292-2031
Mailing Address - Fax:225-295-9678
Practice Address - Street 1:404 LLAMA DR
Practice Address - Street 2:SUITE A
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4785
Practice Address - Country:US
Practice Address - Phone:501-268-2292
Practice Address - Fax:501-305-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4971251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128805514Medicaid
047057Medicare Oscar/Certification