Provider Demographics
NPI:1184086175
Name:COMPLETE HEALTH WITH PACE
Entity type:Organization
Organization Name:COMPLETE HEALTH WITH PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND CFO OF BAPTIST HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-1542
Mailing Address - Street 1:2100 PIKE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-2604
Mailing Address - Country:US
Mailing Address - Phone:501-376-8852
Mailing Address - Fax:501-978-2801
Practice Address - Street 1:2100 PIKE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2604
Practice Address - Country:US
Practice Address - Phone:501-376-8852
Practice Address - Fax:501-978-2801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-28
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARH6342251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR16PACE1Medicaid