Provider Demographics
NPI:1871009142
Name:OLIVIA'S SENIOR HOME CARE LLC
Entity Type:Organization
Organization Name:OLIVIA'S SENIOR HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:LARANJO
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:479-285-5241
Mailing Address - Street 1:2120 S WALDRON RD STE 3B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3655
Mailing Address - Country:US
Mailing Address - Phone:479-242-5883
Mailing Address - Fax:479-242-1925
Practice Address - Street 1:5111 ROGERS AVE STE 504
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2041
Practice Address - Country:US
Practice Address - Phone:479-285-5241
Practice Address - Fax:479-551-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR224878732Medicaid
AR235081732Medicaid
AR231546797Medicaid
AR235081732Medicaid
ARAR5470OtherARKANSAS LICENSE