Provider Demographics
NPI:1992838080
Name:STATE OF ARKANSAS
Entity Type:Organization
Organization Name:STATE OF ARKANSAS
Other - Org Name:IN HOME SERVICE CBCM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAZIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-661-2154
Mailing Address - Street 1:CASE MANAGEMENT SLOT H5
Mailing Address - Street 2:PO BOX 1437
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-1437
Mailing Address - Country:US
Mailing Address - Phone:501-661-2873
Mailing Address - Fax:501-280-4619
Practice Address - Street 1:5800 W 10TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1752
Practice Address - Country:US
Practice Address - Phone:501-661-2873
Practice Address - Fax:501-280-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management