Provider Demographics
NPI:1295790103
Name:LITTLE ROCK HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:LITTLE ROCK HOME HEALTH AGENCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NATIONAL CONTRACTS
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS, MBA
Authorized Official - Phone:847-303-5300
Mailing Address - Street 1:2401 S PLUM GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:847-303-5300
Mailing Address - Fax:847-303-5376
Practice Address - Street 1:11524 N RODNEY PARHAM RD
Practice Address - Street 2:#1
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4187
Practice Address - Country:US
Practice Address - Phone:501-223-3333
Practice Address - Fax:501-228-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
ARAR4768251J00000X, 251F00000X
ARAR4090251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137741738Medicaid
AR138499757Medicaid
AR14192765Medicaid
AR138507750Medicaid
AR137740514Medicaid
AR138506752Medicaid
AR141492765Medicaid
AR139100742Medicaid
AR137742732Medicaid
AR138506752Medicaid