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Contact Information

STATE OF ARKANSAS
87 REED RD
HIGHWAY 116 SOUTH
BOONEVILLE, AR72927
 Phone: 479-675-2121
 Fax: 479-675-5820
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Intermediate Care Facility, Mentally Retarded

315P00000X
Indicates primary specialty

NPI Profile & details for STATE OF ARKANSAS

NPI Number 1801928627
LBN Legal business name STATE OF ARKANSAS
Authorized official JUDY STOREY - (DIRECTOR OF OPERATIONS)
Entity Organization
Organization subpart 1 No
Enumeration date 03/09/2007
Last updated 06/25/2008 - About 18 years ago
Identifiers
AR Medicaid 109051213
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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