MEDICARE: GRACE HILL QBHP

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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker	PLMSW	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720672728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE HILL QBHP

Provider Business Mailing Address
First Line	:	203B WESTPORT DR
Second Line	:
City	:	CABOT
State	:	AR
Zip	:	72023-3657
Country	:	US
Telephone Number	:	501-843-9233
Fax Number	:	501-843-9656

Provider Business Practice Location Address
First Line	:	350 SALEM RD STE 9
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-7521
Country	:	US
Telephone Number	:	501-336-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	06/09/2023

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Directions to “ GRACE HILL QBHP” Practice Location

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