Provider Demographics
NPI:1952964140
Name:ARROWSTAR LIVING ASSISTANCE SERVICES
Entity Type:Organization
Organization Name:ARROWSTAR LIVING ASSISTANCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-632-5000
Mailing Address - Street 1:1659 S HIGHWAY 65 82
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-1661
Mailing Address - Country:US
Mailing Address - Phone:870-632-5000
Mailing Address - Fax:
Practice Address - Street 1:1659 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1661
Practice Address - Country:US
Practice Address - Phone:870-632-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care