# 1 SOURCE SENIOR CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619501087
- **Authorized official:** CATHY ROBERTSON (OWNER)
- **Authorized official phone:** (479) 443-7173

## Contact information

- **Practice address:** 1820 SHELBY LN STE A, FAYETTEVILLE, AR 72704-5255
- **Practice address phone:** (479) 443-7173
- **Practice address fax:** (479) 443-0183
- **Mailing address:** 1820 SHELBY LN STE A, FAYETTEVILLE, AR 72704-5255
- **Mailing address phone:** (479) 443-7173
- **Mailing address fax:** (479) 443-0183

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 02/25/2020
- **Last updated:** 03/26/2024