Provider Demographics
NPI:1801973904
Name:EAST ARKANSAS AREA AGENCY ON AGING, INC.
Entity type:Organization
Organization Name:EAST ARKANSAS AREA AGENCY ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-930-2212
Mailing Address - Street 1:PO BOX 5035
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-5035
Mailing Address - Country:US
Mailing Address - Phone:870-930-2212
Mailing Address - Fax:870-930-2230
Practice Address - Street 1:2005 E HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6123
Practice Address - Country:US
Practice Address - Phone:870-930-2212
Practice Address - Fax:870-930-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120547765Medicaid
AR164423798Medicaid