Provider Demographics
NPI:1003301292
Name:LIBCARE OF AR
Entity type:Organization
Organization Name:LIBCARE OF AR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-255-0489
Mailing Address - Street 1:PO BOX 242184
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0021
Mailing Address - Country:US
Mailing Address - Phone:501-255-0489
Mailing Address - Fax:
Practice Address - Street 1:10500 W MARKHAM ST STE 105
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2187
Practice Address - Country:US
Practice Address - Phone:501-255-0489
Practice Address - Fax:501-255-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR385H00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR231545732Medicaid
AR234064797Medicaid