Provider Demographics
NPI:1871670059
Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC
Entity Type:Organization
Organization Name:ARKANSAS ELDER OUTREACH OF LITTLE ROCK, INC
Other - Org Name:EASTRIDGE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIBODEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-7960
Mailing Address - Street 1:2305 RICHARD ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-3223
Mailing Address - Country:US
Mailing Address - Phone:337-892-9800
Mailing Address - Fax:337-892-9875
Practice Address - Street 1:2305 RICHARD ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-3223
Practice Address - Country:US
Practice Address - Phone:337-892-9800
Practice Address - Fax:337-892-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA748314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1521124Medicaid
LA1521124Medicaid