Provider Demographics
NPI:1780999193
Name:SUPPORT SOLUTIONS OF ARKANSAS
Entity type:Organization
Organization Name:SUPPORT SOLUTIONS OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:901-383-9193
Mailing Address - Street 1:818 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-5075
Mailing Address - Country:US
Mailing Address - Phone:901-383-9193
Mailing Address - Fax:901-383-9195
Practice Address - Street 1:5909 SHELBY OAKS DR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7318
Practice Address - Country:US
Practice Address - Phone:901-383-9193
Practice Address - Fax:901-383-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445321Medicaid