Provider Demographics
NPI:1811083587
Name:SOUTHEAST ARKANSAS HOSPICE LTD CO
Entity type:Organization
Organization Name:SOUTHEAST ARKANSAS HOSPICE LTD CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:RASPBERRY
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:870-850-7152
Mailing Address - Street 1:1401 S STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-5856
Mailing Address - Country:US
Mailing Address - Phone:870-850-7152
Mailing Address - Fax:870-850-7413
Practice Address - Street 1:1401 S STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5856
Practice Address - Country:US
Practice Address - Phone:870-850-7152
Practice Address - Fax:870-850-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR4100251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11566OtherBLUE CROSS BLUE SHIELD
AR148705747Medicaid
AR041566Medicare ID - Type Unspecified