Provider Demographics
NPI:1265780944
Name:OZARK ADULT PERSONAL CARE LLC
Entity type:Organization
Organization Name:OZARK ADULT PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-368-4419
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0906
Mailing Address - Country:US
Mailing Address - Phone:870-368-4419
Mailing Address - Fax:870-368-4094
Practice Address - Street 1:1234 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-9316
Practice Address - Country:US
Practice Address - Phone:870-368-4419
Practice Address - Fax:870-368-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190746757Medicaid
AR193026732Medicaid
AR192867796Medicaid
AR190744752Medicaid
AR192868797Medicaid