MEDICARE: DEWITT HOSPITAL & NURSING HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	047100	AR

General Provider Information

NPI Number	:	1477535995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEWITT HOSPITAL & NURSING HOME INC.

Provider Business Mailing Address
First Line	:	1203 S WHITEHEAD DR
Second Line	:	PO BOX 32
City	:	DE WITT
State	:	AR
Zip	:	72042-3702
Country	:	US
Telephone Number	:	870-946-2848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 S WHITEHEAD DR
Second Line	:
City	:	DE WITT
State	:	AR
Zip	:	72042-3702
Country	:	US
Telephone Number	:	870-946-2848
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JANICE VAUGHAN
Credential	:	RN
Telephone Number	:	870-946-2301

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	12/07/2007

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