STATE OF ARKANSAS (NPI# 1417052895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417052895 |
| Entity Type | Organization |
| Organization Name | STATE OF ARKANSAS |
| Other Organization Name | ARKANSAS STATE VETERANS HOME AT FAYETTEVILLE |
| Practice Address |
1179 N. College Avenue Fayetteville AR 72703 |
| Mailing Address |
1179 N. College Ave Fayetteville AR 72703 |
| Practice Telephone | 4794447001 |
| Practice Fax Number | 4796950814 |
| Mailing Telephone | 4794447001 |
| Mailing Fax Number | 4796950184 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-11-21 |
| Authorized Official Name | MR. BUSTER MCCALL (ADMINISTRATOR) |
| Authorized Official Telephone | 4794447001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 803 | AR | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 160958311 | 05 |
| Other Name | Type Code |
|---|---|
| Arkansas State Veterans Home at Fayetteville | Other Name - Individual/Organization |
| Arkansas Veterans Home at Fayetteville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689117756 | State of Arkansas | Skilled Nursing Facility | 2401 John Ashley Drive, Building #100, North Little Rock, AR 72114 | 2016-11-22 |
| 1023236163 | State of Arkansas | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1 Center Cir, Warren, AR 71671-3033 | 2007-04-23 |
| 1477672608 | State of Arkansas | Case Management | 5800 W 10th St Ste 300, Arkansas Dhhs, Little Rock, AR 72204-1764 | 2007-03-28 |
| 1801928627 | State of Arkansas | Intermediate Care Facility, Mentally Retarded | 87 Reed Rd, Highway 116 South, Booneville, AR 72927 | 2007-03-09 |
| 1407988355 | State of Arkansas | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1 Prator Drive, Arkadelphia, AR 71923 | 2007-03-09 |
| 1487781027 | State of Arkansas | Intermediate Care Facility, Mentally Retarded | 14701 Highway 111, Alexander, AR 72002-1742 | 2007-02-28 |
| 1386770030 | State of Arkansas | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4701 Colony Dr, Jonesboro, AR 72404-9317 | 2007-02-26 |
| 1093840282 | State of Arkansas | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 150 Siebenmorgen Rd, Conway, AR 72032 | 2007-02-21 |
| 1912014192 | State of Arkansas | Home Health | # 22 Sherwood Plaza, Johnson County Health Unit, Clarksville, AR 72830-4337 | 2006-08-24 |
| 1649280694 | State of Arkansas | Home Health | 100 E 20th, Suite E & F Hempstead County Health Unit, Hope, AR 71801-8213 | 2006-08-09 |
| Street Address |
1179 N. COLLEGE AVENUE |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831625037 | Supplemental Healthcare | Skilled Nursing Facility | 319 Vancouver Drive, Apartment 38g, Fayetteville, NC 28303 | 2017-05-08 |
| 1659764447 | Kathleen Mason | Skilled Nursing Facility | 13 Lorelei Dr, Fayetteville, OH 45118-8404 | 2015-03-18 |
| 1083917413 | Autumn Corporation | Skilled Nursing Facility | 1401 71st School Rd, Fayetteville, NC 28314-2814 | 2010-12-07 |
| 1194044941 | Wcnc, Inc. | Skilled Nursing Facility | 4405 Persimmon Street, Fayetteville, AR 72704 | 2010-05-19 |
| 1962674796 | Tison Speech Therapy Services | Skilled Nursing Facility | 1387 N Bernice Dr, Fayetteville, AR 72703-6086 | 2008-04-01 |
| 1851443022 | Washington Regional Medicorp, Inc. | Skilled Nursing Facility | 221 S School Ave, Fayetteville, AR 72701-5969 | 2007-01-17 |
| 1871659730 | Fayette Nursing & Rehabilitation Center LLC | Skilled Nursing Facility | 100 Hresan Blvd, Fayetteville, WV 25840-1333 | 2006-12-28 |
| 1740368612 | Lafayette Health Care Center, Inc. | Skilled Nursing Facility | 110 Brandywine Blvd, Fayetteville, GA 30214-1500 | 2006-11-01 |
| 1699886085 | Highland House of Fayetteville, Inc | Skilled Nursing Facility | 1700 Pamalee Dr, Fayetteville, NC 28301-2824 | 2006-08-31 |
| 1487760765 | Piney Partners Lp | Skilled Nursing Facility | 6375 Chambersburg Rd, Fayetteville, PA 17222-8350 | 2006-08-21 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on STATE OF ARKANSAS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.