Provider Demographics
NPI:1700120383
Name:ABOVE & BEYOND HOME CARE INC
Entity Type:Organization
Organization Name:ABOVE & BEYOND HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-609-1906
Mailing Address - Street 1:206 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1363
Mailing Address - Country:US
Mailing Address - Phone:870-609-1906
Mailing Address - Fax:870-609-1907
Practice Address - Street 1:2379 HIGHWAY 62 412
Practice Address - Street 2:SUITE H
Practice Address - City:HIGHLAND
Practice Address - State:AR
Practice Address - Zip Code:72542-9393
Practice Address - Country:US
Practice Address - Phone:870-856-3030
Practice Address - Fax:870-856-3033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABOVE & BEYOND HOME CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4821253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190637757Medicaid
AR190668752Medicaid