1 SOURCE SENIOR CARE (NPI# 1619501087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619501087 |
| Entity Type | Organization |
| Organization Name | 1 SOURCE SENIOR CARE |
| Practice Address |
1820 Shelby Ln Fayetteville AR 72704-5255 |
| Practice Telephone | 4794437173 |
| Practice Fax Number | 4794430183 |
| Mailing Telephone | 4794437173 |
| Mailing Fax Number | 4794430183 |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2020-02-25 |
| Authorized Official Name | JULIA ROBERTSON (OWNER) |
| Authorized Official Telephone | 4794437173 |
| Is Organization Subpart | Y |
| Parent Organization Name | 1 SOURCE SENIOR CARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171M00000X | Case Manager/Care Coordinator | Other Service Providers |
| Street Address |
1820 SHELBY LN |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72704-5255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598387037 | Anne-ashley Hull | Speech-Language Pathologist | 12905 Randolph Road, Fayetteville, AR 72704 | 2020-05-07 |
| 1427607019 | Destiny Bound, LLC | Midwife | 3825 N Salem Road, Fayetteville, AR 72704 | 2019-09-06 |
| 1043796881 | Travis Alexander | Physical Therapist | 3399 Black Forest Dr Ste 3, Fayetteville, AR 72704 | 2018-07-16 |
| 1104319433 | Rise Physical Therapy Pa | Clinic/Center | 3484 W Wedington Dr Ste 4, Fayetteville, AR 72704 | 2018-06-12 |
| 1346744232 | Wedington Dental, Pllc | Clinic/Center | 3500 Black Forest Drvie, Ste 1, Fayetteville, AR 72704 | 2018-03-23 |
| 1528410487 | Sharon Byrd | Licensed Practical Nurse | 17836 Harmon Rd, Fayetteville, AR 72704 | 2016-07-05 |
| 1861823502 | Andrea Warren | Pharmacist | 2875 W Martin Luther King Jr Blvd, Fayetteville, AR 72704 | 2013-12-05 |
| 1609157726 | Jessica Rose Collier | Speech-Language Pathologist | 2020 E Joyce Ave., Suite 2, Fayetteville, AR 72704 | 2011-09-02 |
| 1194044941 | Wcnc, Inc. | Skilled Nursing Facility | 4405 Persimmon Street, Fayetteville, AR 72704 | 2010-05-19 |
| 1841512944 | Jill K Johnston | Speech-Language Pathologist | 3472 N Sandpiper Dr, Fayetteville, AR 72704 | 2010-02-17 |
| Find all providers in zip 72704 | ||||
| Taxonomy Code | 171M00000X |
| Grouping | Other Service Providers |
| Classification | Case Manager/Care Coordinator |
| A person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. |
| Notes: Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700495595 | Brittany Huerta | Case Manager/Care Coordinator | 5649 Gatewood Rd, Fayetteville, WV 25840-5135 | 2020-07-28 |
| 1508474867 | Anna L Kincaid | Case Manager/Care Coordinator | 1257 Terry Ave, Fayetteville, WV 25840-5444 | 2020-07-22 |
| 1326679473 | Megan Thomas | Case Manager/Care Coordinator | 3715 N Business Dr Ste 201, Fayetteville, AR 72703-5288 | 2020-01-28 |
| 1275172298 | Kelsy Timas | Case Manager/Care Coordinator | 143 Skateway Dr, Fayetteville, NC 28304-2640 | 2019-12-23 |
| 1679131726 | Scharmane Porter | Case Manager/Care Coordinator | 110 Westbridge Cir, Fayetteville, GA 30214-2638 | 2019-06-04 |
| 1790259117 | Mackenzie Birdsong | Case Manager/Care Coordinator | 3715 N Business Dr Ste 105, Fayetteville, AR 72703-5287 | 2019-01-18 |
| 1134659162 | Sheila May Reynolds | Case Manager/Care Coordinator | 1872 N Cannondale Dr, Fayetteville, AR 72704-6931 | 2017-06-13 |
| 1528596285 | Alexander Garcia II | Case Manager/Care Coordinator | 1687 W Lodge Way Apt 100a, Fayetteville, AR 72701-5084 | 2017-05-25 |
| 1619414786 | Markese Ware | Case Manager/Care Coordinator | 3715 N Business Dr, Ste 104, Fayetteville, AR 72703-5204 | 2017-01-26 |
| 1245786177 | Joseph James Defrange | Case Manager/Care Coordinator | 3005 W Dorothy Jeanne St Apt 9, Fayetteville, AR 72704-8704 | 2016-08-31 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72704 |
Please comment or provide details below to improve the information on 1 SOURCE SENIOR CARE.
| 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.