Provider Demographics
NPI:1609649748
Name:ARK ANGEL CAREGIVERS
Entity type:Organization
Organization Name:ARK ANGEL CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DORIAN
Authorized Official - Last Name:QUARLES-CULLITON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:501-292-8003
Mailing Address - Street 1:3010 ALDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8103
Mailing Address - Country:US
Mailing Address - Phone:501-292-8003
Mailing Address - Fax:501-415-6086
Practice Address - Street 1:3010 ALDERWOOD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8103
Practice Address - Country:US
Practice Address - Phone:501-292-8003
Practice Address - Fax:501-415-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care