Provider Demographics
NPI:1932120128
Name:STATE OF ARKANSAS
Entity Type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:IZARD COUNTY HEALTH UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:501-661-2540
Mailing Address - Street 1:5800 WEST 10TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1764
Mailing Address - Country:US
Mailing Address - Phone:501-661-2614
Mailing Address - Fax:501-661-2975
Practice Address - Street 1:1015 HALEY ST
Practice Address - Street 2:IZARD COUNTY HEALTH UNIT
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8211
Practice Address - Country:US
Practice Address - Phone:870-368-7790
Practice Address - Fax:870-368-7060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4030251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104312514Medicaid
AR047870Medicare Oscar/Certification